Mina T Mostofi, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401007810 Issued in VA

Practice address

12724 Directors Loop
Lake Ridge, VA 22192-2462

Phone

(703) 494-9171

Fax

(703) 490-4066

NPI assigned

Dec 20, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Interoperability endpoints

• Direct secure messaging: mina.mostofi.p1@direct.mcg-hhs.nextgenshare.com

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.

• Dental Family Practice

  • General Practice Dentistry
  • Lake Ridge, VA
  • NPI 1558483305
  NPD (past) Authorized official

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

{
    "created_epoch": "1198108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198108800000",
    "number": "1972787380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12724 DIRECTORS LOOP",
            "city": "LAKE RIDGE",
            "state": "VA",
            "postal_code": "221922462",
            "telephone_number": "703-494-9171",
            "fax_number": "703-490-4066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12724 DIRECTORS LOOP",
            "city": "LAKE RIDGE",
            "state": "VA",
            "postal_code": "221922462",
            "telephone_number": "703-494-9171",
            "fax_number": "703-490-4066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSTOFI",
        "first_name": "MINA",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-12-20",
        "last_updated": "2007-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401007810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Logan Denise Luke, OTR/L
• Fetnat Faye Masri-Imadi, MD
• Masterpeace Chiropractic Center, P.C.
• May & Hettler, O.D., PLLC
• Lisa Hoang Moser, PT
• Kristina R Murphy, PT, MPT
• Megan Riley Murphy, AUD
• Thao Phuong Nguyen, PHARMD
• Ashley Norman, PT, DPT
• Aldous Peter Joshua Baroro Odulio, PT

• General Practice Dentistry in Lake Ridge, VA
• Providers in Lake Ridge, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2007; 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.