Provider Demographics
NPI:1841761012
Name:KAFASHZADEH, ALI (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:KAFASHZADEH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 WINDY KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3075
Mailing Address - Country:US
Mailing Address - Phone:757-345-9310
Mailing Address - Fax:
Practice Address - Street 1:1090 VERMONT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-4905
Practice Address - Country:US
Practice Address - Phone:757-345-9310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10019341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice