Provider Demographics
NPI:1205511250
Name:RAZFAR, HOSSEIN (DMD)
Entity type:Individual
Prefix:
First Name:HOSSEIN
Middle Name:
Last Name:RAZFAR
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 1:44495 POTTER TER
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-7156
Mailing Address - Country:US
Mailing Address - Phone:571-271-5983
Mailing Address - Fax:
Practice Address - Street 1:508 CYNWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3892
Practice Address - Country:US
Practice Address - Phone:410-819-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18021122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist