Provider Demographics
NPI:1952517310
Name:TAHERI, BEHROOZ (DDS)
Entity Type:Individual
Prefix:
First Name:BEHROOZ
Middle Name:
Last Name:TAHERI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4012 TIMBER OAK TRL
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-6222
Mailing Address - Country:US
Mailing Address - Phone:202-528-1820
Mailing Address - Fax:703-583-2801
Practice Address - Street 1:3114 GOLANSKY BLVD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4231
Practice Address - Country:US
Practice Address - Phone:703-583-2800
Practice Address - Fax:703-583-2800
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA102481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice