MEDICARE: BITA MOGHADDAS DDS

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
1	1223E0200X	Endodontics	53311	CA

General Provider Information

NPI Number	:	1760557474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BITA MOGHADDAS DDS

Provider Business Mailing Address
First Line	:	PO BOX 10612
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92658-5002
Country	:	US
Telephone Number	:	310-927-0552
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 S BRISTOL ST
Second Line	:	SUITE 100
City	:	SANTA ANA
State	:	CA
Zip	:	92704-7319
Country	:	US
Telephone Number	:	714-957-6030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	07/08/2007

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