# ROOT MODERN DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174203871
- **Authorized official:** DR. CHRISKA MUSTAFA DDS (OWNER/DENTIST)
- **Authorized official phone:** (202) 489-5972

## Contact information

- **Practice address:** 250 N WASHINGTON HWY STE A, ASHLAND, VA 23005-1624
- **Practice address phone:** (804) 406-4404
- **Mailing address:** 122 LAURADELL RD, ASHLAND, VA 23005-8228
- **Mailing address phone:** (202) 489-5972

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/19/2023
- **Last updated:** 07/19/2023