Provider Demographics
NPI:1982982252
Name:GHORBANI, PEJMAN (DMD)
Entity Type:Individual
Prefix:
First Name:PEJMAN
Middle Name:
Last Name:GHORBANI
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 1:6050 BURKE COMMONS RD STE D
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2878
Mailing Address - Country:US
Mailing Address - Phone:703-250-5072
Mailing Address - Fax:703-250-5149
Practice Address - Street 1:6050 BURKE COMMONS RD STE D
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-2878
Practice Address - Country:US
Practice Address - Phone:703-250-5072
Practice Address - Fax:703-250-5149
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10010291223G0001X
VA04014132611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice