Provider Demographics
NPI:1740679455
Name:SAHRAI, MAHBOUBEH (DDS)
Entity type:Individual
Prefix:
First Name:MAHBOUBEH
Middle Name:
Last Name:SAHRAI
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 1:1003 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-3801
Mailing Address - Country:US
Mailing Address - Phone:301-725-1002
Mailing Address - Fax:
Practice Address - Street 1:2600 VIRGINIA AVE NW STE 501
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037
Practice Address - Country:US
Practice Address - Phone:202-922-2900
Practice Address - Fax:202-922-2900
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1001446122300000X
MD15674122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist