Provider Demographics
NPI:1770910671
Name:NOROOZ, MOSTAFA (DDS)
Entity type:Individual
Prefix:MR
First Name:MOSTAFA
Middle Name:
Last Name:NOROOZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 M L KING WAY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-383-3713
Mailing Address - Fax:253-383-0874
Practice Address - Street 1:314 M L KING WAY
Practice Address - Street 2:SUITE 206
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-383-3713
Practice Address - Fax:253-383-0874
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00007466122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist