Basic Information
| Provider Information | |||||||||
| NPI: | 1235567488 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARAZ | ||||||||
| FirstName: | MOJDEH | ||||||||
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| Credential: | D.D.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 675 CONTRA COSTA BLVD | ||||||||
| Address2: | |||||||||
| City: | PLEASANT HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945231514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317283661 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1400 PELHAM PARKWAY SOUTH, | ||||||||
| Address2: | JACOBI MEDICAL CENTER | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189185000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2013 | ||||||||
| LastUpdateDate: | 10/06/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | 100997 | CA | Y | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.