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Individual

DR. KOUROSH SEIFOLAHI BAZARJANI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
1801 ROBERT FULTON DR STE 100, RESTON, VA 20191-4347
(703) 495-3333
Mailing address
1801 ROBERT FULTON DR STE 100, RESTON, VA 20191-4347
(703) 495-3333

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401417219
VA
1223G0001X
General Practice Dentistry
0401417219
VA

Other

Enumeration date
10/12/2020
Last updated
02/11/2021
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