Provider Demographics
NPI:1689782856
Name:MOSTAGHIM, DARIUSH (DDS MS)
Entity type:Individual
Prefix:DR
First Name:DARIUSH
Middle Name:
Last Name:MOSTAGHIM
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47330 VISTA COURT
Mailing Address - Street 2:
Mailing Address - City:POTOMAC FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:20165-7619
Mailing Address - Country:US
Mailing Address - Phone:703-404-0788
Mailing Address - Fax:
Practice Address - Street 1:2112 F STREET NW
Practice Address - Street 2:SUITE 304
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2755
Practice Address - Country:US
Practice Address - Phone:202-785-1999
Practice Address - Fax:202-785-1948
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN46371223G0001X
VA04010081681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
B01007651OtherFEDERAL DEA