Organization
AVANTI SPECIALTY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FARSHAD FARHOUMAND (OWNER)
(703) 625-6229
Entity
Organization
Contact information
Practice address
1500 CORNERSIDE BLVD STE 500, TYSONS CORNER, VA 22182-2440
(703) 625-6229
(703) 821-0692
Mailing address
1500 CORNERSIDE BLVD STE 500, TYSONS CORNER, VA 22182-2440
(703) 625-6229
(703) 821-0692
Taxonomy
Speciality
Code
Description
License number
State
1223D0004X
Dental Anesthesiology
0438000311
VA
1223E0200X
Endodontics
0401411183
VA
1223G0001X
General Practice Dentistry
Primary
0401004998
VA
1223P0300X
Periodontics
0401412973
VA
1223P0700X
Prosthodontics
0401414238
VA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
0438000311
VA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
0401413394
VA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
0401413955
VA
Other
Enumeration date
04/27/2016
Last updated
04/27/2016
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