Jiries Peter Mogannam D.D.S., M.D.

NPI 1609056878 - Oral & Maxillofacial Surgery - 204E00000X

NPI Details
NPI 1609056878
Gender Male
Enumeration Date 11/05/2007
Last Updated 08/17/2011
Entity Type Individual
Active Over 9 years ago
Practice Location
1111 SONOMA AVE
SUITE #220
SANTA ROSA CA, 95405-4819, US
Phone (707) 566-7300
Fax
Business Location
1111 SONOMA AVE
SUITE #220
SANTA ROSA CA, 95405-4819, US
Phone (707) 566-7300
Fax
Toxanomy
Taxonomy Code 204E00000X
License State California
License Number A114965
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According to our database, Dr. Jiries Peter Mogannam D.D.S., M.D. NPI is 1609056878, taxonomy code is 204E00000X and license number is A114965, license state is located at California. Jiries Peter Mogannam D.D.S., M.D. physically located at 1111 Sonoma Ave, Santa Rosa CA, 95405-4819. NPI Number Jiries Peter Mogannam D.D.S., M.D. has the Individual type.

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1609056878 NPI number is provided on an as is basis without warranty of any kind. 1609056878 is maintained by the National Plan & Provider Enumeration System. The contents of Jiries Peter Mogannam D.D.S., M.D. are for informational purposes only.