Provider Demographics
NPI:1285256784
Name:MOGHADDASSI, NOUSHIN (DMD)
Entity type:Individual
Prefix:DR
First Name:NOUSHIN
Middle Name:
Last Name:MOGHADDASSI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 RODERICK COURT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L4E 0B4
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 RODERICK COURT
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:ONTARIO
Practice Address - Zip Code:L4E 0B4
Practice Address - Country:CA
Practice Address - Phone:905-237-2562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN19065122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist