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General NPI Number Information
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NPI Number | 1023432937
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Entity Type | Individual
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Provider Name | MOJGAN NIKTASH DDS
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Gender | Female
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Dates
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Enumeration Date | 02/12/2014
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Last Update Date | 08/12/2014
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Provider Practice Location Address
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Address Line | 31726 RANCHO VIEJO RD SUITE# B-109
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2779
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Country | US
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Telephone | 949-481-2121
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Fax | 949-218-7556
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Provider Business Mailing Address
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Address Line | 28801 WESTPORT WAY
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-4664
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Country | US
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Telephone | 949-371-3066
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 45598
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License Number State | CA
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