Provider Demographics
NPI:1508147190
Name:JABBAR DARJANI, MOEIN (DDS)
Entity Type:Individual
Prefix:
First Name:MOEIN
Middle Name:
Last Name:JABBAR DARJANI
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 1:1145 19TH ST NW STE 314
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-3717
Mailing Address - Country:US
Mailing Address - Phone:310-402-4038
Mailing Address - Fax:
Practice Address - Street 1:1145 19TH ST NW STE 314
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3717
Practice Address - Country:US
Practice Address - Phone:310-402-4038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055711-11223E0200X, 1223G0001X
PADS0408601223E0200X
CA634681223E0200X
VA04014130971223E0200X
MD148231223G0001X
DCDEN10017011223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice