Healthcare Provider Details

I. General information

NPI: 1699068221
Provider Name (Legal Business Name): MOZHGAN MONA MOKARRAM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 ALHAMBRA AVE
MARTINEZ CA
94553
US

IV. Provider business mailing address

735 ALHAMBRA AVE
MARTINEZ CA
94553-1601
US

V. Phone/Fax

Practice location:
  • Phone: 925-228-6734
  • Fax: 925-228-6770
Mailing address:
  • Phone: 925-228-6734
  • Fax: 925-228-6770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number41484
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number41484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: