Provider Demographics
NPI:1588647259
Name:MOZAFFARI, JAHANGIR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAHANGIR
Middle Name:
Last Name:MOZAFFARI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 W 117TH ST
Mailing Address - Street 2:APT. 3D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-1559
Mailing Address - Country:US
Mailing Address - Phone:212-749-9597
Mailing Address - Fax:
Practice Address - Street 1:535 W 110TH ST
Practice Address - Street 2:SUITE 1G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-2086
Practice Address - Country:US
Practice Address - Phone:212-749-9597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-26
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0496211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice