1730391723 NPI number — DULLES DENTAL CENTER, P.C.

Table of content: (NPI 1730391723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730391723 NPI number — DULLES DENTAL CENTER, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DULLES DENTAL CENTER, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730391723
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1035 STERLING RD
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
HERNDON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20170-3838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-471-8080
Provider Business Mailing Address Fax Number:
703-471-5354

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1035 STERLING RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
HERNDON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20170-3868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-471-8080
Provider Business Practice Location Address Fax Number:
703-471-5354
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ABBASSI
Authorized Official First Name:
FIROUZEH
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
703-471-8080

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  0401007323 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2407323 . This is a "DELTA DENTAL-NEW JERSEY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 602999 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: Z81548 . This is a "BCBS-MASSACHUSETTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 8724 . This is a "BCBS-MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 069063 . This is a "ANTHEM-TRIGON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 412173 . This is a "BCBS-TENNESSEE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 923-87911 . This is a "BCBS-ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 2155650 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".




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