Provider Demographics
NPI:1750479697
Name:MIRA DENTAL CARE PLLC
Entity Type:Organization
Organization Name:MIRA DENTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:MOHAMMAD
Authorized Official - Last Name:MOGHARBEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-807-0808
Mailing Address - Street 1:1800 N KENT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209
Mailing Address - Country:US
Mailing Address - Phone:703-807-0808
Mailing Address - Fax:703-807-8652
Practice Address - Street 1:1800 N KENT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209
Practice Address - Country:US
Practice Address - Phone:703-807-0808
Practice Address - Fax:703-807-8652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014112961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty