Provider Demographics
NPI:1982813994
Name:JAFARI, SORAYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SORAYA
Middle Name:
Last Name:JAFARI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14060 TRAVILAH RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3524
Mailing Address - Country:US
Mailing Address - Phone:301-424-0501
Mailing Address - Fax:301-424-0502
Practice Address - Street 1:14060 TRAVILAH RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3524
Practice Address - Country:US
Practice Address - Phone:301-424-0501
Practice Address - Fax:301-424-0502
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD105001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice