Provider Demographics
NPI:1104086669
Name:MOVAGHAR, BABAK (DDS)
Entity type:Individual
Prefix:DR
First Name:BABAK
Middle Name:
Last Name:MOVAGHAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-4852
Mailing Address - Country:US
Mailing Address - Phone:312-622-0854
Mailing Address - Fax:
Practice Address - Street 1:7 HEMION RD
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4919
Practice Address - Country:US
Practice Address - Phone:845-357-3244
Practice Address - Fax:845-357-3251
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.027495122300000X
NY057127122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist