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General NPI Number Information
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NPI Number | 1700244068
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Entity Type | Individual
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Provider Name | RAMIZ MOGANNAM DMD
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Gender | Male
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Dates
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Enumeration Date | 02/02/2016
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 885 SCOTT BLVD #1
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City | SANTA CLARA
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State | CA
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Zip | 95050-5549
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Country | US
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Telephone | 408-243-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 35 VISTA CT
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City | SOUTH SAN FRANCISCO
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State | CA
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Zip | 94080-5549
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Country | US
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Telephone |
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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 | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 65324
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License Number State | CA
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