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General NPI Number Information
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NPI Number | 1912849795
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Entity Type | Organization
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Legal Business Name | MIRPANAH & FAZEL DENTAL
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Dates
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Enumeration Date | 04/08/2026
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Last Update Date | 04/08/2026
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Provider Practice Location Address
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Address Line | 984 FIRST COLONIAL RD STE 200
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-3196
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Country | US
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Telephone | 757-412-2235
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Fax |
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Provider Business Mailing Address
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Address Line | 9626 21ST BAY ST
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City | NORFOLK
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State | VA
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Zip | 23518-1609
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Country | US
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Telephone | 703-650-8265
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JACOB MIRPANAH
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Credential | DDS, MS
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Telephone | 703-650-8265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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