Provider Demographics
NPI:1154163434
Name:GHOCHAGHI, NEGAR (DDS, PHD)
Entity type:Individual
Prefix:
First Name:NEGAR
Middle Name:
Last Name:GHOCHAGHI
Suffix:
Gender:
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12137 JAMIESON PL
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5473
Mailing Address - Country:US
Mailing Address - Phone:804-385-2384
Mailing Address - Fax:
Practice Address - Street 1:342 MULE ACADEMY RD
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2256
Practice Address - Country:US
Practice Address - Phone:540-221-6635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014189871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice