Provider Demographics
NPI:1861685927
Name:MOJAB, ALI REZA (DDS)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:REZA
Last Name:MOJAB
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 1:3313 PRINTEMPS DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9313
Mailing Address - Country:US
Mailing Address - Phone:209-545-7993
Mailing Address - Fax:
Practice Address - Street 1:1439 CEDARWOOD LN
Practice Address - Street 2:STE D
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6151
Practice Address - Country:US
Practice Address - Phone:925-484-1202
Practice Address - Fax:925-484-1271
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56145122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist