# MODARESI & AVIN DDS PLLC

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

## Provider details

- **NPI number:** 1477160547
- **Authorized official:** DR. MINA MODARESI DDS (OWNER)
- **Authorized official phone:** (571) 334-8209

## Contact information

- **Practice address:** 24805 PINEBROOK RD STE 112, CHANTILLY, VA 20152-4127
- **Practice address phone:** (571) 334-8209
- **Mailing address:** 24805 PINEBROOK RD STE 112, CHANTILLY, VA 20152-4127
- **Mailing address phone:** (571) 334-8209

## Taxonomy

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

## Other

- **Enumeration date:** 09/23/2020
- **Last updated:** 09/23/2020