Provider Demographics
NPI:1700968930
Name:ANDALIBI-ABADAN, MOZHGAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOZHGAN
Middle Name:
Last Name:ANDALIBI-ABADAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MAGGIE
Other - Middle Name:
Other - Last Name:ABADAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:4765 CARMEL MOUNTAIN RD
Mailing Address - Street 2:SUITE# 205
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-6657
Mailing Address - Country:US
Mailing Address - Phone:858-350-7400
Mailing Address - Fax:858-350-7444
Practice Address - Street 1:4765 CARMEL MOUNTAIN RD
Practice Address - Street 2:SUITE# 205
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-6657
Practice Address - Country:US
Practice Address - Phone:858-350-7400
Practice Address - Fax:858-350-7444
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA482191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice