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General NPI Number Information
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NPI Number | 1437365228
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Entity Type | Individual
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Provider Name | TANYA DEE MOUCHAHOIR D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 307 MAPLE AVE W SUITE A
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City | VIENNA
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State | VA
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Zip | 22180-4307
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Country | US
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Telephone | 703-281-7104
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Fax |
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Provider Business Mailing Address
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Address Line | 43341 ROYAL BURKEDALE ST
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City | SOUTH RIDING
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State | VA
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Zip | 20152-1781
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Country | US
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Telephone | 703-327-0670
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401410521
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License Number State | VA
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