Provider Demographics
NPI:1598881872
Name:TAMADDON, MOJGAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOJGAN
Middle Name:
Last Name:TAMADDON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12903 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-2923
Mailing Address - Country:US
Mailing Address - Phone:818-752-7525
Mailing Address - Fax:818-752-7527
Practice Address - Street 1:12903 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-2923
Practice Address - Country:US
Practice Address - Phone:818-752-7525
Practice Address - Fax:818-752-7527
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA494171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice