Provider Demographics
NPI:1699891093
Name:SHOJAEI, MARIAH A (DMD, MSC, MSD)
Entity type:Individual
Prefix:DR
First Name:MARIAH
Middle Name:A
Last Name:SHOJAEI
Suffix:
Gender:F
Credentials:DMD, MSC, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46161 WESTLAKE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:POTOMAC FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5871
Mailing Address - Country:US
Mailing Address - Phone:703-406-3180
Mailing Address - Fax:703-406-4466
Practice Address - Street 1:46161 WESTLAKE DR STE 120
Practice Address - Street 2:
Practice Address - City:POTOMAC FALLS
Practice Address - State:VA
Practice Address - Zip Code:20165-5871
Practice Address - Country:US
Practice Address - Phone:703-406-3180
Practice Address - Fax:703-406-4466
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014103511223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics