Provider Demographics
NPI:1457565178
Name:AMIR MOJAVER DMD PC
Entity Type:Organization
Organization Name:AMIR MOJAVER DMD PC
Other - Org Name:MODERN DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MOJAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:858-259-4765
Mailing Address - Street 1:500 WEST HARBOR DR.
Mailing Address - Street 2:#303
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101
Mailing Address - Country:US
Mailing Address - Phone:619-206-1774
Mailing Address - Fax:
Practice Address - Street 1:4765 CARMEL MOUNTAIN RD.
Practice Address - Street 2:STE. 208
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130
Practice Address - Country:US
Practice Address - Phone:858-259-4765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA519771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty