Provider Demographics
NPI:1871623686
Name:MOZAFFARI, JAMACK (DDS)
Entity type:Individual
Prefix:MISS
First Name:JAMACK
Middle Name:
Last Name:MOZAFFARI
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 1:7455 RESEDA BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-7461
Mailing Address - Country:US
Mailing Address - Phone:310-383-0851
Mailing Address - Fax:
Practice Address - Street 1:1902 CALIFORNIA AVE # 101
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4440
Practice Address - Country:US
Practice Address - Phone:310-383-0851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55134122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist