Healthcare Provider Details

I. General information

NPI: 1750807475
Provider Name (Legal Business Name): NASEM MOJARRAD DMD APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 08/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26700 TOWNE CENTRE DR STE 270
FOOTHILL RANCH CA
92610-2844
US

IV. Provider business mailing address

26700 TOWNE CENTER DRIVE SUITE 270
FOOTHILL RANCH CA
92610
US

V. Phone/Fax

Practice location:
  • Phone: 949-668-0686
  • Fax:
Mailing address:
  • Phone: 949-668-0686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number60343
License Number StateCA

VIII. Authorized Official

Name: DR. NASEM M DUNLOP
Title or Position: PRESIDENT
Credential: DMD
Phone: 949-668-0686