Provider Demographics
NPI:1659591006
Name:SHAFIEYAN, MOJGAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MOJGAN
Middle Name:
Last Name:SHAFIEYAN
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 1:333 SOUTH OXFORD VALLEY RD.
Mailing Address - Street 2:SUITE#505
Mailing Address - City:FAIRLESS HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19030
Mailing Address - Country:US
Mailing Address - Phone:215-269-1439
Mailing Address - Fax:215-269-4622
Practice Address - Street 1:333 S. OXFORD VALLEY RD.
Practice Address - Street 2:STE.#505
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030
Practice Address - Country:US
Practice Address - Phone:215-269-1439
Practice Address - Fax:215-269-4622
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029267L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice