Provider Demographics
NPI:1902287915
Name:GOWHARJI, NOUR (BDS,DMD)
Entity Type:Individual
Prefix:DR
First Name:NOUR
Middle Name:
Last Name:GOWHARJI
Suffix:
Gender:F
Credentials:BDS,DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13350 FRANKLIN FARM RD
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-4091
Mailing Address - Country:US
Mailing Address - Phone:571-549-8011
Mailing Address - Fax:
Practice Address - Street 1:13350 FRANKLIN FARM RD
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4091
Practice Address - Country:US
Practice Address - Phone:517-549-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADF110381223P0221X
VA04014161691223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry