Provider Demographics
NPI:1609909126
Name:MOJAVER, MAHNAZ NINA (DMD)
Entity Type:Individual
Prefix:
First Name:MAHNAZ
Middle Name:NINA
Last Name:MOJAVER
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 1:450 A ST STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-4217
Mailing Address - Country:US
Mailing Address - Phone:619-233-3338
Mailing Address - Fax:619-233-3035
Practice Address - Street 1:15835 POMERADO RD STE 101
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2042
Practice Address - Country:US
Practice Address - Phone:858-487-4727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA406811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice