Provider Demographics
NPI:1629762075
Name:SHAGHATI, MUSTAFA (DDS)
Entity Type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:
Last Name:SHAGHATI
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 1:25654 CABIN POINT CT
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-5700
Mailing Address - Country:US
Mailing Address - Phone:202-808-1252
Mailing Address - Fax:
Practice Address - Street 1:25654 CABIN POINT CT
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-5700
Practice Address - Country:US
Practice Address - Phone:202-808-1252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401418473122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist