Provider Demographics
NPI:1740457621
Name:MOZAFFARIAN, MANA (DMD)
Entity type:Individual
Prefix:DR
First Name:MANA
Middle Name:
Last Name:MOZAFFARIAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 S 15TH ST UNIT 1608
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2208
Mailing Address - Country:US
Mailing Address - Phone:215-971-0109
Mailing Address - Fax:
Practice Address - Street 1:1233 LOCUST ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5453
Practice Address - Country:US
Practice Address - Phone:215-525-3046
Practice Address - Fax:215-732-1478
Is Sole Proprietor?:No
Enumeration Date:2008-05-10
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040251122300000X
NJ22DI02357500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist