Individual
JACOB MIRPANAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
13516 HULL STREET RD, MIDLOTHIAN, VA 23112-2107
(804) 293-4000
Mailing address
44040 BRUCETON MILLS CIR, ASHBURN, VA 20147-4808
(703) 650-8265
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401417927
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/07/2022
Last updated
06/21/2022
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