Individual provider · NPI-1

Mojgan Ansari

Dentist · Puyallup, WA

NPI number1689307142
StatusActive
Last updated in NPPESJul 2, 2022

Details

NPI
1689307142
Entity type
Individual (NPI-1)
Name
Mojgan Ansari
Sex
Female
Sole proprietor
Yes
Enumeration date
Jul 2, 2022
Certification date
Jul 2, 2022
Last updated
Jul 2, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
122300000X DentistDE61198512WAYes

Practice location

732 Shaw Rd Ste B
Puyallup, WA 98372-5278

Phone 253-267-7112

Mailing address

732 Shaw Rd Ste B
Puyallup, WA 98372-5278

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Dentist providers in Puyallup, WA