Provider Demographics
NPI:1417137357
Name:RAJA, TAIMOUR JAN (DDS)
Entity type:Individual
Prefix:DR
First Name:TAIMOUR
Middle Name:JAN
Last Name:RAJA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1366 SINGLETON LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-8803
Mailing Address - Country:US
Mailing Address - Phone:434-409-3893
Mailing Address - Fax:
Practice Address - Street 1:11700 PLAZA AMERICA DR STE 140
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-4753
Practice Address - Country:US
Practice Address - Phone:434-249-3793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014119941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice