Provider Demographics
NPI:1285617258
Name:MOFAKHAMI, NILOOFAR (DDS)
Entity type:Individual
Prefix:DR
First Name:NILOOFAR
Middle Name:
Last Name:MOFAKHAMI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2944 HUNTER MILL RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-1761
Mailing Address - Country:US
Mailing Address - Phone:703-255-3434
Mailing Address - Fax:703-255-3429
Practice Address - Street 1:2960 CHAIN BRIDGE RD STE 300
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124
Practice Address - Country:US
Practice Address - Phone:703-255-3434
Practice Address - Fax:703-255-3429
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014104871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry