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General NPI Number Information
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NPI Number | 1003705971
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Entity Type | Organization
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Legal Business Name | MOJAVER PERIODONTICS INC
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Dates
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Enumeration Date | 07/02/2025
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 13522 SABRE SPRINGS PKWY STE 201
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City | SAN DIEGO
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State | CA
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Zip | 92128-4687
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Country | US
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Telephone | 858-513-1747
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Fax |
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Provider Business Mailing Address
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Address Line | 945 CREST RD
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City | DEL MAR
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State | CA
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Zip | 92014-2617
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Country | US
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Telephone | 858-357-1778
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. SEAN MOJAVER
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Credential | DDS, MSOB
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Telephone | 858-357-1778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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