Individual
DR. MITRA DERAKHSHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS MS
Contact information
Practice address
5082 DORSEY HALL DR STE 202, ELLICOTT CITY, MD 21042-7754
(202) 445-4972
Mailing address
794 GRANT ST, HERNDON, VA 20170-4631
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
12731
MD
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
49090
CA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
DEN1000677
DC
Other
Enumeration date
12/01/2017
Last updated
03/17/2018
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