MEDICARE: DR. MOJGAN MAZHARI DDS

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	0401008682	VA

General Provider Information

NPI Number	:	1558697755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOJGAN MAZHARI DDS

Provider Business Mailing Address
First Line	:	2847 DUKE ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-4512
Country	:	US
Telephone Number	:	703-212-9622
Fax Number	:	703-212-9624

Provider Business Practice Location Address
First Line	:	2847 DUKE ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-4512
Country	:	US
Telephone Number	:	703-212-9622
Fax Number	:	703-212-9624

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

Provider Enumeration Date	:	10/22/2009
Last Update Date	:	05/26/2022

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