Provider Demographics
NPI:1861983108
Name:GHOFRANIAN, NEDA MICHELLE (DMD)
Entity type:Individual
Prefix:
First Name:NEDA
Middle Name:MICHELLE
Last Name:GHOFRANIAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 W FOOTHILL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-6603
Mailing Address - Country:US
Mailing Address - Phone:626-873-1500
Mailing Address - Fax:
Practice Address - Street 1:925 W FOOTHILL BLVD STE B
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-6603
Practice Address - Country:US
Practice Address - Phone:626-873-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS103333122300000X
AZD010010122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist