Provider Demographics
NPI:1124308424
Name:MOJAHEDI, CARMELLA (BDS, DDS)
Entity type:Individual
Prefix:DR
First Name:CARMELLA
Middle Name:
Last Name:MOJAHEDI
Suffix:
Gender:F
Credentials:BDS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 SCRIPPS DRIVE
Mailing Address - Street 2:STE. 302
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825
Mailing Address - Country:US
Mailing Address - Phone:916-567-1800
Mailing Address - Fax:916-567-0069
Practice Address - Street 1:87 SCRIPPS DRIVE
Practice Address - Street 2:STE. 302
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:916-567-1800
Practice Address - Fax:916-567-0069
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA359501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice