Provider Demographics
NPI:1225235344
Name:JAMALI, MOJGAN KAKROUDI (DDS)
Entity Type:Individual
Prefix:
First Name:MOJGAN
Middle Name:KAKROUDI
Last Name:JAMALI
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 1:2251 PIMMIT DR
Mailing Address - Street 2:#1426
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-2811
Mailing Address - Country:US
Mailing Address - Phone:443-463-2883
Mailing Address - Fax:
Practice Address - Street 1:10630 CRESTWOOD DR
Practice Address - Street 2:SUITE B
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-4405
Practice Address - Country:US
Practice Address - Phone:703-330-5578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014109461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice