Healthcare Provider Details

I. General information

NPI: 1356092225
Provider Name (Legal Business Name): RAHA YOUSEFI DDS MPH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 19TH ST NW STE 308
WASHINGTON DC
20036-2468
US

IV. Provider business mailing address

1234 19TH ST NW STE 308
WASHINGTON DC
20036-2468
US

V. Phone/Fax

Practice location:
  • Phone: 202-393-6154
  • Fax:
Mailing address:
  • Phone: 202-393-6154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: RAHA YOUSEFI
Title or Position: PERIODONTIST
Credential: DDS
Phone: 724-816-6393