Provider Demographics
NPI:1942993316
Name:MOZAFFARI, PEYMAUN AFSHAR (DMD)
Entity Type:Individual
Prefix:
First Name:PEYMAUN
Middle Name:AFSHAR
Last Name:MOZAFFARI
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 1:8840 N WESTERN AVE APT 2H
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4158
Mailing Address - Country:US
Mailing Address - Phone:773-905-4610
Mailing Address - Fax:
Practice Address - Street 1:229 W GRAND AVE STE W
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-3365
Practice Address - Country:US
Practice Address - Phone:630-574-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190342481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice