Basic Information
| Provider Information | |||||||||
| NPI: | 1740457621 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOZAFFARIAN | ||||||||
| FirstName: | MANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 SANSOM ST | ||||||||
| Address2: | APT. 10A | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191035101 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1233 LOCUST ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155253046 | ||||||||
| FaxNumber: | 2157321478 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2008 | ||||||||
| LastUpdateDate: | 11/01/2016 | ||||||||
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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 | 122300000X | DS040251 | PA | Y | Dental Providers | Dentist |
No ID Information.