Provider Demographics
NPI:1457736597
Name:MAX MOSSLEHI,D.M.D.,INC
Entity type:Organization
Organization Name:MAX MOSSLEHI,D.M.D.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAJID
Authorized Official - Middle Name:MAX
Authorized Official - Last Name:MOSSLEHI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-838-6100
Mailing Address - Street 1:513 E 1ST ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3348
Mailing Address - Country:US
Mailing Address - Phone:714-838-6100
Mailing Address - Fax:714-838-2403
Practice Address - Street 1:513 E 1ST ST
Practice Address - Street 2:SUITE A
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3348
Practice Address - Country:US
Practice Address - Phone:714-838-6100
Practice Address - Fax:714-838-2403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty