Mogannam, Jiries Peter

Mogannam, Jiries Peter is an sole proprietor health care provider with primary practice located at 1111 Sonoma Ave Suite #220, Santa Rosa CA 95405-4819. He recently has 2 registered licenses in different health care specialties including Dental Providers / Oral and Maxillofacial Surgery, Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery. Dental Providers / Oral and Maxillofacial Surgery is his primary health care specialty. Mogannam, Jiries Peter can be contacted via phone (707) 566-7300.

Contact Information

Primary practice address
1111 Sonoma Ave Suite #220 Santa Rosa CA 95405-4819
Phone: (707) 566-7300
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 60191 California
Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery 204E00000X A114965 California

Profile Details

NPI number 1609056878
LBN Legal business name Mogannam, Jiries Peter
Credentials D.D.S., M.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 5th, 2007
Last updated Aug 17th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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