Individual provider · Type 1 NPI

Jiries Peter Mogannam, DDS, MD

Oral and Maxillofacial Surgery (Dentist) · Santa Rosa, CA

NPI number 1609056878 Active

Practice location

1111 Sonoma Ave, Suite #220
Santa Rosa, CA 95405-4819

Call (707) 566-7300 Map

Specialties and licenses

TaxonomyCodeLicense
Oral and Maxillofacial Surgery (Dentist) Primary 1223S0112X60191 (CA)
Oral & Maxillofacial Surgery (D.M.D.) 204E00000XA114965 (CA)

Oral and Maxillofacial Surgery (Dentist): The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

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About NPI 1609056878

Jiries Peter Mogannam, DDS, MD's National Provider Identifier is 1609056878, issued on Nov 5, 2007. The primary taxonomy on file is Oral and Maxillofacial Surgery (Dentist) (1223S0112X), and the practice location is in Santa Rosa, CA. The record was last updated on Aug 17, 2011.