Provider Demographics
NPI:1194419911
Name:ZANDI MOGHADAM, ARYAN (DDS)
Entity type:Individual
Prefix:
First Name:ARYAN
Middle Name:
Last Name:ZANDI MOGHADAM
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 1:26251 BUSCADOR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-3240
Mailing Address - Country:US
Mailing Address - Phone:949-705-9456
Mailing Address - Fax:
Practice Address - Street 1:1629 S RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-7707
Practice Address - Country:US
Practice Address - Phone:909-421-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1085701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice