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Organization
KAMBIZ AND KAMRAN TAVAKKOLI DMD, PC
Active
Organization
KAMBIZ AND KAMRAN TAVAKKOLI DMD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAMBIZ TAVAKKOLI DMD (DOCTOR)
(703) 494-3176
Entity
Organization
Contact information
Practice address
12500 LAKE RIDGE DR, WOODBRIDGE, VA 22192-2354
(703) 494-3176
(703) 494-8207
Mailing address
12500 LAKE RIDGE DR, WOODBRIDGE, VA 22192-2354
(703) 494-3176
(703) 494-8207
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401410837
VA
1223G0001X
General Practice Dentistry
0401410838
VA
Other
Enumeration date
03/22/2007
Last updated
08/22/2020
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