Provider Demographics
NPI:1790977510
Name:GOLESTAN, MOJTABA (DDS)
Entity Type:Individual
Prefix:MR
First Name:MOJTABA
Middle Name:
Last Name:GOLESTAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 HURLEY WAY STE 135
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-3298
Mailing Address - Country:US
Mailing Address - Phone:916-641-7700
Mailing Address - Fax:916-641-7702
Practice Address - Street 1:2020 HURLEY WAY STE 135
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-5143
Practice Address - Country:US
Practice Address - Phone:412-580-5811
Practice Address - Fax:916-641-7702
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA559751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice