Provider Demographics
NPI:1174675227
Name:GHAFFARPOUR, MANDANA (DDS)
Entity type:Individual
Prefix:DR
First Name:MANDANA
Middle Name:
Last Name:GHAFFARPOUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:
Other - Last Name:GHAFFARPOUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:104 N ELLIOTT RD STE C
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-5837
Mailing Address - Country:US
Mailing Address - Phone:919-942-7163
Mailing Address - Fax:
Practice Address - Street 1:104 N ELLIOTT RD STE C
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-5837
Practice Address - Country:US
Practice Address - Phone:919-942-7163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC71331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899013XMedicaid