Provider Demographics
NPI:1306009550
Name:SASAN MOGHADDAME-JAFARI MS DDS PA
Entity Type:Organization
Organization Name:SASAN MOGHADDAME-JAFARI MS DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SASAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOGHADDAME-JAFARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-984-3636
Mailing Address - Street 1:11921 ROCKVILLE PIKE
Mailing Address - Street 2:405
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2737
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11921 ROCKVILLE PIKE
Practice Address - Street 2:405
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2737
Practice Address - Country:US
Practice Address - Phone:301-984-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD131901223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty