# ADVANCED DENTAL ANESTHESIA PLLC

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

## Provider details

- **NPI number:** 1609357235
- **Authorized official:** REZA IZADI DO (OWNER)
- **Authorized official phone:** (202) 265-0508

## Contact information

- **Practice address:** 10611 BRADDOCK RD, FAIRFAX, VA 22032-2201
- **Practice address phone:** (202) 265-0805
- **Mailing address:** 2776 S ARLINGTON MILL DR \# 121, ARLINGTON, VA 22206-3402

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | FI5268405 | VA | Yes |

## Other

- **Enumeration date:** 08/22/2018
- **Last updated:** 08/22/2018