Provider Demographics
NPI:1295219137
Name:NESHAT, MAHNOUSH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAHNOUSH
Middle Name:
Last Name:NESHAT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MAHNOUSH
Other - Middle Name:
Other - Last Name:NESHASTEHRIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1830 FOUNTAIN DR UNIT 906
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-4474
Mailing Address - Country:US
Mailing Address - Phone:703-608-9474
Mailing Address - Fax:
Practice Address - Street 1:1746 COLUMBIA RD NW STE G
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2863
Practice Address - Country:US
Practice Address - Phone:202-797-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10018741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice