Provider Demographics
NPI:1780702126
Name:MOHAMMADI, MARYAM (DDS)
Entity type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:
Last Name:MOHAMMADI
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 1:1007 BELLVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-1101
Mailing Address - Country:US
Mailing Address - Phone:703-734-3770
Mailing Address - Fax:
Practice Address - Street 1:1363 BEVERLY RD
Practice Address - Street 2:SUITE 250
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3660
Practice Address - Country:US
Practice Address - Phone:703-752-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA86101223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry