# SHERRY ANOUSHFAR D D S P C

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

## Provider details

- **NPI number:** 1629492871
- **Authorized official:** DR. MOHSEN IZADI D.D.S. (DOCTOR)
- **Authorized official phone:** (703) 319-9880

## Contact information

- **Practice address:** 133 MAPLE AVE E, 206, VIENNA, VA 22180-5741
- **Practice address phone:** (703) 319-9880
- **Practice address fax:** (703) 319-9985
- **Mailing address:** 133 MAPLE AVE E, SUITE 206, VIENNA, VA 22180-5741
- **Mailing address phone:** (703) 319-9880
- **Mailing address fax:** (703) 319-9985

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 7484 | VA | Yes |
| 332BC3200X | Customized Equipment (DME) | — | NULL | — |

## Other

- **Enumeration date:** 02/08/2014
- **Last updated:** 08/22/2014