Provider Demographics
NPI:1366467011
Name:ABREU, MAHVASSH FOROUTAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAHVASSH
Middle Name:FOROUTAN
Last Name:ABREU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13508 FALLEN OAK CT
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-2429
Mailing Address - Country:US
Mailing Address - Phone:703-961-9489
Mailing Address - Fax:
Practice Address - Street 1:1712 I ST NW
Practice Address - Street 2:SUITE 906
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-3702
Practice Address - Country:US
Practice Address - Phone:202-496-0891
Practice Address - Fax:202-496-0894
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC59061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice