# SASAN AHMADIYAR, DDS,PLLC

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

## Provider details

- **NPI number:** 1396259586
- **Authorized official:** DR. SASAN AHMADIYAR DDS (DENTIST)
- **Authorized official phone:** (703) 299-1200

## Contact information

- **Practice address:** 1911 BALLENGER AVE, ALEXANDRIA, VA 22314-6819
- **Practice address phone:** (703) 299-1200
- **Mailing address:** 10608 LEAVELLS RD, FREDERICKSBURG, VA 22407-1256
- **Mailing address phone:** (540) 710-6000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 0401008767 | VA | Yes |
| 1223G0001X | General Practice Dentistry | — | NULL | — |
| 1223G0001X | General Practice Dentistry | — | — | — |

## Other

- **Enumeration date:** 11/27/2017
- **Last updated:** 11/27/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1699801787 | — | VA |