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Individual

MAHSASADAT MORTAZAVI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
6505 SYDENSTRICKER RD STE B, BURKE, VA 22015-4282
(703) 691-5343
Mailing address
1747 TYSONS CENTRAL ST APT 2407, VIENNA, VA 22182-6058
(510) 333-1711

Taxonomy

Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
0401417746
VA

Other

Enumeration date
07/20/2022
Last updated
07/20/2022
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