Provider Demographics
NPI:1053823336
Name:SPRINGFIELD DENTAL GROUP, PC
Entity Type:Organization
Organization Name:SPRINGFIELD DENTAL GROUP, PC
Other - Org Name:SPRINGFIELD DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DMD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOJARRAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-295-5683
Mailing Address - Street 1:PO BOX 920050
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75392-0050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8056 ROLLING RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22153-2928
Practice Address - Country:US
Practice Address - Phone:571-295-5683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty