Provider Demographics
NPI:1730793555
Name:MOSTAFAVI, DELARAM (DDS)
Entity type:Individual
Prefix:
First Name:DELARAM
Middle Name:
Last Name:MOSTAFAVI
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 1:3883 TURTLE CREEK BLVD APT 1704
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4465
Mailing Address - Country:US
Mailing Address - Phone:214-843-5517
Mailing Address - Fax:
Practice Address - Street 1:3200 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-4404
Practice Address - Country:US
Practice Address - Phone:972-252-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35374122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist