Provider Demographics
NPI:1649865163
Name:RAHA MOZAFFARI DMD LLC
Entity type:Organization
Organization Name:RAHA MOZAFFARI DMD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOZAFFARI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-739-2543
Mailing Address - Street 1:435 E FLORA ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-3315
Mailing Address - Country:US
Mailing Address - Phone:215-740-3912
Mailing Address - Fax:
Practice Address - Street 1:244 E GIRARD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-3929
Practice Address - Country:US
Practice Address - Phone:215-739-2543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental