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General NPI Number Information
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NPI Number | 1982149522
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Entity Type | Organization
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Legal Business Name | GHORBANI - MOHAMMADI DENTAL P.C.
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Dates
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Enumeration Date | 01/05/2017
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Last Update Date | 01/05/2017
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Provider Practice Location Address
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Address Line | 2676 E MAIN ST COLUMBIA DENTAL
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City | BRIDGEPORT
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State | CT
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Zip | 06610-1422
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Country | US
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Telephone | 408-313-3228
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Fax |
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Provider Business Mailing Address
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Address Line | 2676 E MAIN ST COLUMBIA DENTAL
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City | BRIDGEPORT
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State | CT
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Zip | 06610-1422
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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 | PRESIDENT
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Name | HAMED GHORBANI-MOGHADDAM
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Credential | D.D.S.
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Telephone | 408-313-3228
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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 | 8514
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 11154
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License Number State | CT
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