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Organization
TYSONS MODERN DENTISTRY, PC
Active
Organization
TYSONS MODERN DENTISTRY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALI SHAHRESTANI (OWNER)
(714) 845-8500
Entity
Organization
Contact information
Practice address
8393 LEESBURG PIKE, VIENNA, VA 22182-2402
(703) 745-1797
Mailing address
PO BOX 920050, DALLAS, TX 75392-0050
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
02/25/2022
Last updated
02/25/2022
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