Provider Demographics
NPI:1760557474
Name:MOGHADDAS, BITA (DDS)
Entity Type:Individual
Prefix:
First Name:BITA
Middle Name:
Last Name:MOGHADDAS
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:PO BOX 10612
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-5002
Mailing Address - Country:US
Mailing Address - Phone:310-927-0552
Mailing Address - Fax:
Practice Address - Street 1:3500 S BRISTOL ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7319
Practice Address - Country:US
Practice Address - Phone:714-957-6030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA533111223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics