Healthcare Provider Details

I. General information

NPI: 1972398832
Provider Name (Legal Business Name): SASAN MOGHANJOGHI MOKHTARI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N 11TH ST
RICHMOND VA
23219-1901
US

IV. Provider business mailing address

PO BOX 980257
RICHMOND VA
23298-0257
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-0602
  • Fax: 804-593-4279
Mailing address:
  • Phone: 804-828-9783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0442000544
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: