Provider Demographics
NPI:1578108288
Name:REZA MOGHBEL DDS INC
Entity Type:Organization
Organization Name:REZA MOGHBEL DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOGHBEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-709-3330
Mailing Address - Street 1:4000 STOCKDALE HWY STE A
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-2059
Mailing Address - Country:US
Mailing Address - Phone:310-709-3330
Mailing Address - Fax:
Practice Address - Street 1:4000 STOCKDALE HWY STE A
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-2059
Practice Address - Country:US
Practice Address - Phone:310-709-3330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment