# SOUTH RIDING ORAL AND IMPLANT SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** South Riding Oral and Implant Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285296814
- **Authorized official:** DR. KAMRAN RAJA DMD, MD (OWNER)
- **Authorized official phone:** (571) 218-0878

## Contact information

- **Practice address:** 24805 PINEBROOK RD \# 318, CHANTILLY, VA 20152-4126
- **Practice address phone:** (571) 218-0878
- **Mailing address:** 9209 MAROVELLI FOREST DR, LORTON, VA 22079-3456
- **Mailing address phone:** (571) 218-0878

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 07/03/2019
- **Last updated:** 07/03/2019