Provider Demographics
NPI:1336238658
Name:HARIRI-VIJEH, MOJDEH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOJDEH
Middle Name:
Last Name:HARIRI-VIJEH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 GRAND AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2022
Mailing Address - Country:US
Mailing Address - Phone:510-251-1962
Mailing Address - Fax:510-251-8333
Practice Address - Street 1:3645 GRAND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2022
Practice Address - Country:US
Practice Address - Phone:510-251-1962
Practice Address - Fax:510-251-8333
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA412601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice