Individual
SEYED OMID DIANAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
13880 BRADDOCK RD STE 307, CENTREVILLE, VA 20121-2462
(703) 815-3636
Mailing address
13880 BRADDOCK RD STE 307, CENTREVILLE, VA 20121-2462
(703) 815-3636
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
0401417091
VA
Other
Enumeration date
07/24/2020
Last updated
07/24/2020
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