Provider Demographics
NPI:1891968772
Name:ZOMORRODI, MANDANA ANOOSHEH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANDANA
Middle Name:ANOOSHEH
Last Name:ZOMORRODI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:ANOOSHEH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3245 OLD CONEJO RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-2152
Mailing Address - Country:US
Mailing Address - Phone:805-498-4400
Mailing Address - Fax:805-498-3510
Practice Address - Street 1:3245 OLD CONEJO RD
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-2152
Practice Address - Country:US
Practice Address - Phone:805-498-4400
Practice Address - Fax:805-498-3510
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35810122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist