Provider Demographics
NPI:1356743397
Name:MOSTOFI, PASHA (MD, DMD)
Entity type:Individual
Prefix:DR
First Name:PASHA
Middle Name:
Last Name:MOSTOFI
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7757 S MINGO RD APT 236
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-3332
Mailing Address - Country:US
Mailing Address - Phone:925-300-6216
Mailing Address - Fax:
Practice Address - Street 1:7322 E 91ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6016
Practice Address - Country:US
Practice Address - Phone:925-300-6216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA63619OtherDENTAL BOARD OF CALIFORNIA