=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356092225
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAHA YOUSEFI DDS MPH PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2022
-----------------------------------------------------
Last Update Date | 01/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1234 19TH ST NW STE 308
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20036-2468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-393-6154
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1234 19TH ST NW STE 308
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20036-2468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-393-6154
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PERIODONTIST
-----------------------------------------------------
Name | RAHA YOUSEFI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 724-816-6393
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------