Provider Demographics
NPI:1376623587
Name:MAHBOUBI, HOSSEIN (DDS)
Entity Type:Individual
Prefix:
First Name:HOSSEIN
Middle Name:
Last Name:MAHBOUBI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4307 BEL PRE ROAD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853
Mailing Address - Country:US
Mailing Address - Phone:301-871-8700
Mailing Address - Fax:301-871-6979
Practice Address - Street 1:4307 BEL PRE ROAD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20853
Practice Address - Country:US
Practice Address - Phone:301-871-8700
Practice Address - Fax:301-871-6979
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11731122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist