Healthcare Provider Details

I. General information

NPI: 1285617258
Provider Name (Legal Business Name): NILOOFAR MOFAKHAMI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 CHAIN BRIDGE RD STE 300
OAKTON VA
22124
US

IV. Provider business mailing address

2944 HUNTER MILL RD SUITE 202
OAKTON VA
22124-1761
US

V. Phone/Fax

Practice location:
  • Phone: 703-255-3434
  • Fax: 703-255-3429
Mailing address:
  • Phone: 703-255-3434
  • Fax: 703-255-3429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401410487
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: