Provider Demographics
NPI:1386255073
Name:MAHJOUR, FARANAK (DDS, PHD)
Entity type:Individual
Prefix:DR
First Name:FARANAK
Middle Name:
Last Name:MAHJOUR
Suffix:
Gender:F
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 1:609 E MAIN ST STE P
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-3182
Mailing Address - Country:US
Mailing Address - Phone:540-900-0970
Mailing Address - Fax:540-767-5227
Practice Address - Street 1:609 E MAIN ST STE P
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-3182
Practice Address - Country:US
Practice Address - Phone:540-900-0970
Practice Address - Fax:540-767-5227
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-14
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014171411223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics