Provider Demographics
NPI:1689258220
Name:MAHMOODI, MUJAHIDA (DDS)
Entity type:Individual
Prefix:
First Name:MUJAHIDA
Middle Name:
Last Name:MAHMOODI
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 1:50 DUNN DR STE 105
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-1500
Mailing Address - Country:US
Mailing Address - Phone:571-242-0162
Mailing Address - Fax:
Practice Address - Street 1:50 DUNN DR STE 105
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-1500
Practice Address - Country:US
Practice Address - Phone:571-242-0162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN2000061122300000X
390200000X
VA0401417640122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program