Provider Demographics
NPI:1053460386
Name:VESSALI, MOJDEH (DDS)
Entity Type:Individual
Prefix:
First Name:MOJDEH
Middle Name:
Last Name:VESSALI
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 1:505 HUNTMAR PARK DR
Mailing Address - Street 2:STE #150
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170
Mailing Address - Country:US
Mailing Address - Phone:703-736-0900
Mailing Address - Fax:703-736-0666
Practice Address - Street 1:505 HUNTMAR PARK DR
Practice Address - Street 2:STE #150
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170
Practice Address - Country:US
Practice Address - Phone:703-736-0900
Practice Address - Fax:703-736-0666
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007994122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist