# LEESBURG MODERN DENTISTRY, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Leesburg Modern Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932837101
- **Authorized official:** ALI SHAHRESTANI DMD (OWNER DOCTOR)
- **Authorized official phone:** (571) 899-4713

## Contact information

- **Practice address:** 502 E MARKET ST, LEESBURG, VA 20176-4112
- **Practice address phone:** (571) 899-4713
- **Practice address fax:** (571) 982-7616
- **Mailing address:** PO BOX 920050, DALLAS, TX 75392-0050
- **Mailing address phone:** (714) 845-8890
- **Mailing address fax:** (303) 952-0892

## Taxonomy

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

## Other

- **Enumeration date:** 08/15/2022
- **Last updated:** 08/15/2022