Healthcare Provider Details

I. General information

NPI: 1780748970
Provider Name (Legal Business Name): MEHRDAD VAJDI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 NEW HAMPSHIRE AVE NW #100
WASHINGTON DC
20037-2346
US

IV. Provider business mailing address

908 NEW HAMPSHIRE AVE NW #100
WASHINGTON DC
20037-2346
US

V. Phone/Fax

Practice location:
  • Phone: 202-822-3787
  • Fax: 202-822-3747
Mailing address:
  • Phone: 202-822-3787
  • Fax: 202-822-3747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5025
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: