Healthcare Provider Details

I. General information

NPI: 1003430653
Provider Name (Legal Business Name): PEGA MOGHADAM HAJIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7239 MECHANICSVILLE TPKE STE 3
MECHANICSVILLE VA
23111-3557
US

IV. Provider business mailing address

1729 W CARY ST
RICHMOND VA
23220-5308
US

V. Phone/Fax

Practice location:
  • Phone: 804-746-7545
  • Fax:
Mailing address:
  • Phone: 818-212-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401417805
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401417805
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: