Provider Demographics
NPI:1588919682
Name:MOOTABAR, NAVA (DDS)
Entity type:Individual
Prefix:DR
First Name:NAVA
Middle Name:
Last Name:MOOTABAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BRETTON RDG
Mailing Address - Street 2:
Mailing Address - City:BEDFORD CORNERS
Mailing Address - State:NY
Mailing Address - Zip Code:10549-4701
Mailing Address - Country:US
Mailing Address - Phone:914-242-1042
Mailing Address - Fax:
Practice Address - Street 1:597 ROUTE 22
Practice Address - Street 2:
Practice Address - City:CROTON FALLS
Practice Address - State:NY
Practice Address - Zip Code:10519
Practice Address - Country:US
Practice Address - Phone:914-277-5580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0498631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice