Provider Demographics
NPI:1366679011
Name:MONICA MOUSSANEJAD DDS INC
Entity type:Organization
Organization Name:MONICA MOUSSANEJAD DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSSANEJAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-708-3828
Mailing Address - Street 1:5620 WILBUR AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1311
Mailing Address - Country:US
Mailing Address - Phone:818-708-3828
Mailing Address - Fax:
Practice Address - Street 1:5620 WILBUR AVE STE 300
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1311
Practice Address - Country:US
Practice Address - Phone:818-708-3828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA507881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty