Provider Demographics
NPI:1063689164
Name:DASTGIR, MAJID (DMD)
Entity type:Individual
Prefix:DR
First Name:MAJID
Middle Name:
Last Name:DASTGIR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11717 BOWMAN GREEN DR
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3501
Mailing Address - Country:US
Mailing Address - Phone:571-313-8415
Mailing Address - Fax:571-313-0539
Practice Address - Street 1:11717 BOWMAN GREEN DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3501
Practice Address - Country:US
Practice Address - Phone:571-313-8415
Practice Address - Fax:571-313-0539
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0357711223G0001X
VA04014181931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice