Provider Demographics
NPI:1912627415
Name:MOZHGANI, NILOOFAR (DDS)
Entity Type:Individual
Prefix:
First Name:NILOOFAR
Middle Name:
Last Name:MOZHGANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27182 WOODBLUFF RD
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7533
Mailing Address - Country:US
Mailing Address - Phone:408-849-8806
Mailing Address - Fax:
Practice Address - Street 1:27182 WOODBLUFF RD
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7533
Practice Address - Country:US
Practice Address - Phone:408-849-8806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107807122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist