# CHANTILLY MODERN DENTISTRY, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Chantilly Modern Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013405950
- **Authorized official:** DR. ALEX R SHARIFIAN DDS (OWNER/DDS)
- **Authorized official phone:** (703) 214-2113

## Contact information

- **Practice address:** 14337 NEWBROOK DR., SUITE 200, CHANTILLY, VA 20151
- **Practice address phone:** (703) 214-2113
- **Mailing address:** PO BOX 920050, DALLAS, TX 75392-0050
- **Mailing address phone:** (714) 845-8280

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 04/26/2018
- **Last updated:** 08/05/2022