Healthcare Provider Details

I. General information

NPI: 1598669681
Provider Name (Legal Business Name): MZ DENTAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 CENTREVILLE RD STE 200
CHANTILLY VA
20151-3280
US

IV. Provider business mailing address

3910 CENTREVILLE RD STE 200
CHANTILLY VA
20151-3280
US

V. Phone/Fax

Practice location:
  • Phone: 202-808-1252
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: MUSTAFA SHAGHATI
Title or Position: DENTIST
Credential: DDS
Phone: 202-808-1252