Provider Demographics
NPI:1043422496
Name:MOSHIRI, TARA TAFRESHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:TAFRESHI
Last Name:MOSHIRI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 BLUE HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-3853
Mailing Address - Country:US
Mailing Address - Phone:703-716-4319
Mailing Address - Fax:
Practice Address - Street 1:46090 LAKE CENTER PLZ
Practice Address - Street 2:SUITE 107
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-5876
Practice Address - Country:US
Practice Address - Phone:703-434-3286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014101361223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice