# DR. MOJDEH VESSALI FAMILY DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942742861
- **Authorized official:** DR. MOJDEH VESSALI DDS (GENERAL DENTIST)
- **Authorized official phone:** (703) 736-0900

## Contact information

- **Practice address:** 505 HUNTMAR PARK DRIVE, \#150, HERNDON, VA 20170
- **Practice address phone:** (703) 736-0900
- **Practice address fax:** (703) 736-0666
- **Mailing address:** 505 HUNTMAR PARK DR, \#150, HERNDON, VA 20170-5103
- **Mailing address phone:** (703) 736-0900
- **Mailing address fax:** (703) 736-0666

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 1223P0300X | Periodontics | — | NULL | — |
| 1223P0300X | Periodontics | — | — | — |

## Other

- **Enumeration date:** 11/09/2016
- **Last updated:** 11/09/2016