Provider Demographics
NPI:1801058466
Name:MOGHADASIAN, BEHNAM Y (DDS)
Entity type:Individual
Prefix:DR
First Name:BEHNAM
Middle Name:Y
Last Name:MOGHADASIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10525 64TH AVE APT 3F
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1644
Mailing Address - Country:US
Mailing Address - Phone:646-283-4553
Mailing Address - Fax:
Practice Address - Street 1:10525 64TH AVE APT 3F
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1644
Practice Address - Country:US
Practice Address - Phone:646-283-4553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0544551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice