Individual
FARNOSH MOJTABAEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1450 W PARMER LN, AUSTIN, TX 78727-4501
(512) 251-6125
Mailing address
3024 SHANE DR, LEANDER, TX 78641-4500
(512) 905-6582
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
35410
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35410
TEXAS STATE BOARD OF DENTAL EXAMINERS
TX
Enumeration date
07/23/2019
Last updated
07/23/2019
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