Provider Demographics
NPI:1619314630
Name:MONA GOODARZI DDS DENTAL CORPORATION
Entity Type:Organization
Organization Name:MONA GOODARZI DDS DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODARZI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-201-4444
Mailing Address - Street 1:16300 SAND CANYON AVE
Mailing Address - Street 2:SUITE 506
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3711
Mailing Address - Country:US
Mailing Address - Phone:949-201-4444
Mailing Address - Fax:949-201-4443
Practice Address - Street 1:16300 SAND CANYON AVE
Practice Address - Street 2:SUITE 506
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3711
Practice Address - Country:US
Practice Address - Phone:949-201-4444
Practice Address - Fax:949-201-4443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty