# RESTON FAMILY DENTIST GROUP PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Reston Family Dental Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265884423
- **Authorized official:** DR. ALI MIAMEE DDS (PRESIDENT)
- **Authorized official phone:** (571) 423-7945

## Contact information

- **Practice address:** 1801 ROBERT FULTON DR, SUITE 100, RESTON, VA 20191-5461
- **Practice address phone:** (571) 423-7945
- **Practice address fax:** (571) 313-0576
- **Mailing address:** 12025 TOWN SQUARE ST, UNIT 424, RESTON, VA 20190-6026
- **Mailing address phone:** (571) 423-7945
- **Mailing address fax:** (571) 313-0576

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 0401412603 | VA | Yes |
| 1223P0300X | Periodontics | 0401412603 | VA | — |

## Other

- **Enumeration date:** 07/12/2016
- **Last updated:** 07/12/2016