Provider Demographics
NPI:1316165848
Name:MOZAYAN, CYRUS KOUROSH (DMD, MDS)
Entity type:Individual
Prefix:DR
First Name:CYRUS
Middle Name:KOUROSH
Last Name:MOZAYAN
Suffix:
Gender:M
Credentials:DMD, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 MISSION DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1827
Mailing Address - Country:US
Mailing Address - Phone:831-465-0140
Mailing Address - Fax:831-465-0141
Practice Address - Street 1:3323 MISSION DR.
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1827
Practice Address - Country:US
Practice Address - Phone:831-465-0140
Practice Address - Fax:831-465-0141
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA421891223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics