Mansour Mortazie, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

0401005721 Issued in VA

Practice address

313 Park Ave
Suite 302
Falls Church, VA 22046-3327

Phone

(703) 237-0662

Fax

(703) 883-1114

NPI assigned

Oct 15, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• James M Chung DDS PC

  • General Practice Dentistry
  • Falls Church, VA
  • NPI 1386501369
  NPD (past)
• James M Chung DDS PC

  • Dental Clinic/Center
  • Falls Church, VA
  • NPI 1598579435
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394582400000",
    "number": "1235128950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 PARK AVE",
            "address_2": "SUITE 302",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220463327",
            "telephone_number": "703-237-0662",
            "fax_number": "703-883-1114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "313 PARK AVE",
            "address_2": "SUITE 302",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220463327",
            "telephone_number": "703-237-0662",
            "fax_number": "703-883-1114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORTAZIE",
        "first_name": "MANSOUR",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-15",
        "last_updated": "2014-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401005721",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007819315",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Traevia Morris
• Courtney Morrison, LCSW
• Kevin Morrison
• Megan Laila Morrison, FNP
• Nancy Able Morrison, M.D.
• Sage Mosavi
• Chelsea Moseley, DPT
• Kim Denise Moses, FNP
• Michael Moses, D.C.
• Myania Moses, OTR/L

• Dentist in Falls Church, VA
• Providers in Falls Church, VA by specialty
• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.