Provider Demographics
NPI:1295055762
Name:ROSTAMI, FARZANEH (DDS)
Entity type:Individual
Prefix:DR
First Name:FARZANEH
Middle Name:
Last Name:ROSTAMI
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 1:4701 RANDOLPH RD STE G10
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2259
Mailing Address - Country:US
Mailing Address - Phone:301-468-0020
Mailing Address - Fax:
Practice Address - Street 1:1145 19TH ST NW STE 777
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3744
Practice Address - Country:US
Practice Address - Phone:022-296-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014133971223S0112X
DCDEN10014181223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty