Provider Demographics
NPI:1609261122
Name:MOBASHER, MARAL EMMA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARAL
Middle Name:EMMA
Last Name:MOBASHER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 ATLANTIC AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1185
Mailing Address - Country:US
Mailing Address - Phone:510-521-5437
Mailing Address - Fax:
Practice Address - Street 1:1105 ATLANTIC AVE STE 101
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-1185
Practice Address - Country:US
Practice Address - Phone:510-521-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1019871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101987OtherCALIFORNIA DENTAL LICENSE