Individual
DR. MANSOUR MORTAZIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
313 PARK AVE, SUITE 302, FALLS CHURCH, VA 22046-3327
(703) 237-0662
(703) 883-1114
Mailing address
313 PARK AVE, SUITE 302, FALLS CHURCH, VA 22046-3327
(703) 237-0662
(703) 883-1114
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401005721
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007819315
—
VA
Enumeration date
10/15/2005
Last updated
03/12/2014
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