Provider Demographics
NPI:1528528783
Name:SIRJANI, MOHAMMAD (DDS)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:SIRJANI
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 1:31 E MACARTHUR CRES STE 109
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-5907
Mailing Address - Country:US
Mailing Address - Phone:714-549-1248
Mailing Address - Fax:714-549-1246
Practice Address - Street 1:31 E MACARTHUR CRES STE 109
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-5907
Practice Address - Country:US
Practice Address - Phone:714-549-1248
Practice Address - Fax:714-549-1246
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-23
Last Update Date:2019-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1024221223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty