Individual
DR. MARYAM MOGHADAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
234 RIDGE AVE, #1, EVANSTON, IL 60202-3349
(847) 864-5491
Mailing address
22778 E POCO CALLE, QUEEN CREEK, AZ 85142-1449
(847) 848-6339
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D010262
AZ
1223G0001X
General Practice Dentistry
019025836
IL
Other
Enumeration date
06/29/2006
Last updated
04/26/2026
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