Provider Demographics
NPI:1942754197
Name:MEHRANFARD, MOJGAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOJGAN
Middle Name:
Last Name:MEHRANFARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MORGAN
Other - Middle Name:
Other - Last Name:MEHRANFARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8 CAMINO ENCINAS
Mailing Address - Street 2:110
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563
Mailing Address - Country:US
Mailing Address - Phone:925-254-3725
Mailing Address - Fax:925-254-3701
Practice Address - Street 1:8 CAMINO ENCINAS STE 110
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-3350
Practice Address - Country:US
Practice Address - Phone:925-254-3725
Practice Address - Fax:925-254-3701
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1003281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice