# KOUROS HEDAYATI, DDS, PLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Breeze Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639603459
- **Authorized official:** DR. KOUROS HEDAYATI DDS (OWNER/DENTIST)
- **Authorized official phone:** (571) 225-1038

## Contact information

- **Practice address:** 3545 CHAIN BRIDGE RD STE 5, FAIRFAX, VA 22030-2708
- **Practice address phone:** (703) 273-5545
- **Practice address fax:** (703) 591-8702
- **Mailing address:** 3545 CHAIN BRIDGE RD STE 5, FAIRFAX, VA 22030-2708
- **Mailing address phone:** (703) 273-5545
- **Mailing address fax:** (703) 591-8702

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 0401412201 | VA | Yes |

## Other

- **Enumeration date:** 04/18/2017
- **Last updated:** 04/18/2017