Provider Demographics
NPI:1235573486
Name:MAJLESSI KOOPAEEI, MAHSHID
Entity Type:Individual
Prefix:
First Name:MAHSHID
Middle Name:
Last Name:MAJLESSI KOOPAEEI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 19TH ST NW STE 314
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-3717
Mailing Address - Country:US
Mailing Address - Phone:202-701-1555
Mailing Address - Fax:
Practice Address - Street 1:308 MAIN ST
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-6574
Practice Address - Country:US
Practice Address - Phone:301-977-9787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10011231223E0200X
MD15162122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentist
No1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty