MEDICARE: FATEMEH MOJARRAD D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	16053	MD

General Provider Information

NPI Number	:	1417326414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FATEMEH MOJARRAD D.D.S.

Provider Business Mailing Address
First Line	:	8120 FENTON ST
Second Line	:	STE 100
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4796
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8120 FENTON ST
Second Line	:	STE 100
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4796
Country	:	US
Telephone Number	:	301-608-9800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2015
Last Update Date	:	09/23/2015

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