# MIRA DENTAL AT TYSONS CORNER PLLC

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

## Provider details

- **NPI number:** 1942826524
- **Authorized official:** DR. NIKHIL SAHA (MEDICAL CLAIM SPECIALIST)
- **Authorized official phone:** (908) 533-4386

## Contact information

- **Practice address:** 8201 GREENSBORO DR STE 710, MC LEAN, VA 22102-3818
- **Practice address phone:** (571) 633-9455
- **Mailing address:** 8201 GREENSBORO DR STE 710, MC LEAN, VA 22102-3818

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 06/19/2020
- **Last updated:** 06/19/2020