Provider Demographics
NPI:1053419739
Name:MOZAFARI-NEJAD, SETAREH (DDS)
Entity type:Individual
Prefix:
First Name:SETAREH
Middle Name:
Last Name:MOZAFARI-NEJAD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SETAREH
Other - Middle Name:
Other - Last Name:MOZAFARI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2335 BRANNER DR
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-6303
Mailing Address - Country:US
Mailing Address - Phone:310-592-0730
Mailing Address - Fax:
Practice Address - Street 1:10055 MILLER AVE
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3472
Practice Address - Country:US
Practice Address - Phone:310-592-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA520901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics