Provider Demographics
NPI:1477045334
Name:MOHAMMADI, SASHA
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:MOHAMMADI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2677 AVENIR PL APT 3427
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-6757
Mailing Address - Country:US
Mailing Address - Phone:913-220-7495
Mailing Address - Fax:
Practice Address - Street 1:100 CORPORATE CENTER DR STE 103
Practice Address - Street 2:
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-4331
Practice Address - Country:US
Practice Address - Phone:412-262-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2024-01-19
Deactivation Date:2023-08-02
Deactivation Code:
Reactivation Date:2023-08-15
Provider Licenses
StateLicense IDTaxonomies
KS613611223G0001X
MD182031223P0300X
VA04014186261223P0300X
PADS0444611223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice