Provider Demographics
NPI:1184726283
Name:MOGHAREI, ALI (DDS)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:MOGHAREI
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 1:2222 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2304
Mailing Address - Country:US
Mailing Address - Phone:310-829-2224
Mailing Address - Fax:310-829-2220
Practice Address - Street 1:2222 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2304
Practice Address - Country:US
Practice Address - Phone:310-829-2224
Practice Address - Fax:310-829-2220
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA512881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice