Provider Demographics
NPI:1609926310
Name:MUJTABA, MONEEZE (DDS)
Entity Type:Individual
Prefix:
First Name:MONEEZE
Middle Name:
Last Name:MUJTABA
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 1:1200 BRICKELL BAY DR
Mailing Address - Street 2:APT 3205
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3251
Mailing Address - Country:US
Mailing Address - Phone:954-272-9250
Mailing Address - Fax:
Practice Address - Street 1:701 PROMENADE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-6034
Practice Address - Country:US
Practice Address - Phone:954-272-9250
Practice Address - Fax:954-272-9251
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN173841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice