Provider Demographics
NPI:1609099464
Name:MOSTAFA NOROOZ, D.D.S., P.S.
Entity Type:Organization
Organization Name:MOSTAFA NOROOZ, D.D.S., P.S.
Other - Org Name:TACOMA MEDICAL CENTER DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOSTAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOROOZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-383-3713
Mailing Address - Street 1:314 M. L. KING WAY
Mailing Address - Street 2:SUITE #206
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-383-3713
Mailing Address - Fax:253-383-0874
Practice Address - Street 1:314 M. L. KING WAY
Practice Address - Street 2:SUITE #206
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-383-3713
Practice Address - Fax:253-383-0874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE07466261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental