Provider Demographics
NPI:1952328502
Name:RAJABALLY, MOHAMAD IQBALL (DDS)
Entity Type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:IQBALL
Last Name:RAJABALLY
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 1:39675 CEDAR BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-5489
Mailing Address - Country:US
Mailing Address - Phone:510-657-5510
Mailing Address - Fax:510-657-5587
Practice Address - Street 1:39675 CEDAR BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-5489
Practice Address - Country:US
Practice Address - Phone:510-657-5510
Practice Address - Fax:510-657-5587
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA364181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3641801OtherMEDICAL