Individual
MEHDI MUSTAFA HASAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4090 LAFAYETTE CENTER DR STE F, CHANTILLY, VA 20151-1244
(410) 706-7116
Mailing address
4327 RAVENSWORTH RD APT 812, ANNANDALE, VA 22003-5652
(410) 905-2271
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
16467
MD
1223G0001X
General Practice Dentistry
Primary
0401415660
VA
Other
Enumeration date
04/13/2017
Last updated
07/21/2022
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