Provider Demographics
NPI:1912970724
Name:MOZAYENI-AZAR, MANDANA (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:MANDANA
Middle Name:
Last Name:MOZAYENI-AZAR
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3189 LANDER RD
Mailing Address - Street 2:
Mailing Address - City:PEPPER PIKE
Mailing Address - State:OH
Mailing Address - Zip Code:44124-5442
Mailing Address - Country:US
Mailing Address - Phone:330-633-7076
Mailing Address - Fax:216-378-8964
Practice Address - Street 1:18 COASTAL OAK
Practice Address - Street 2:
Practice Address - City:NEWPORT COAST
Practice Address - State:CA
Practice Address - Zip Code:92657-1655
Practice Address - Country:US
Practice Address - Phone:216-299-5223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49379122300000X, 1223X0400X
OH216641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist