Provider Demographics
NPI:1881736684
Name:BARAKZOY, MOSTAFA GHULAM (DDS)
Entity type:Individual
Prefix:DR
First Name:MOSTAFA
Middle Name:GHULAM
Last Name:BARAKZOY
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 1:38056 MARTHA AVENUE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-3834
Mailing Address - Country:US
Mailing Address - Phone:510-505-9409
Mailing Address - Fax:510-505-9764
Practice Address - Street 1:38056 MARTHA AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-3809
Practice Address - Country:US
Practice Address - Phone:510-505-9409
Practice Address - Fax:510-505-9764
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44291122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist