Provider Demographics
NPI:1407990252
Name:MEHRABIAN, KOUROSH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KOUROSH
Middle Name:
Last Name:MEHRABIAN
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 1:8120 FENTON STREET
Mailing Address - Street 2:SUITE #100
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910
Mailing Address - Country:US
Mailing Address - Phone:301-608-9800
Mailing Address - Fax:301-608-9331
Practice Address - Street 1:19731 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-1337
Practice Address - Country:US
Practice Address - Phone:301-528-5000
Practice Address - Fax:301-528-0700
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008909122300000X
MD12266122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1154657344Medicaid