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NPI Code Detail

MEDICARE: MONA MAHMOODI DDS INC

MEDICARE: MONA MAHMOODI DDS INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry62200CA

General Provider Information

NPI Number : 1154724763
Entity Type Code : Organization
Provider Name (Legal Business Name) : MONA MAHMOODI DDS INC
Provider Business Mailing Address
First Line : 245 KENTUCKY ST STE E
Second Line :
City : PETALUMA
State : CA
Zip : 94952-2877
Country : US
Telephone Number : 707-763-4142
Fax Number :
Provider Business Practice Location Address
First Line : 245 KENTUCKY ST STE E
Second Line :
City : PETALUMA
State : CA
Zip : 94952-2877
Country : US
Telephone Number : 707-763-4142
Fax Number :
Authorized Official
Title or Position : DDS/DENTIST
Name : DR. MONA MAHMOODI
Credential :
Telephone Number : 310-993-5758
Provider Enumeration Date : 09/28/2014
Last Update Date : 09/28/2014

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