Provider Demographics
NPI:1891967220
Name:JAFARI, MOHAMMAD BAGHER (DMD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:BAGHER
Last Name:JAFARI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12840 RIVERSIDE DR
Mailing Address - Street 2:SUITE # 400
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3327
Mailing Address - Country:US
Mailing Address - Phone:818-762-6060
Mailing Address - Fax:818-762-1765
Practice Address - Street 1:12840 RIVERSIDE DR
Practice Address - Street 2:SUITE # 400
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91607-3327
Practice Address - Country:US
Practice Address - Phone:818-762-6060
Practice Address - Fax:818-762-1765
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA392831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice