# TYSONS MODERN DENTISTRY, PC

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

## Provider details

- **NPI number:** 1508512708
- **Authorized official:** ALI SHAHRESTANI (OWNER)
- **Authorized official phone:** (714) 845-8500

## Contact information

- **Practice address:** 8393 LEESBURG PIKE, VIENNA, VA 22182-2402
- **Practice address phone:** (703) 745-1797
- **Mailing address:** PO BOX 920050, DALLAS, TX 75392-0050

## Taxonomy

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

## Other

- **Enumeration date:** 02/25/2022
- **Last updated:** 02/25/2022