Provider Demographics
NPI:1023432937
Name:NIKTASH, MOJGAN (DDS)
Entity type:Individual
Prefix:DR
First Name:MOJGAN
Middle Name:
Last Name:NIKTASH
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 1:28801 WESTPORT WAY
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4664
Mailing Address - Country:US
Mailing Address - Phone:949-371-3066
Mailing Address - Fax:
Practice Address - Street 1:31726 RANCHO VIEJO RD
Practice Address - Street 2:SUITE# B-109
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2779
Practice Address - Country:US
Practice Address - Phone:949-481-2121
Practice Address - Fax:949-218-7556
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45598122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist