Individual
ELHAM DEHYAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12989 FAIR LAKES SHOPPING CTR, FAIRFAX, VA 22033-5177
(703) 222-1230
Mailing address
24686 LENAH RD, ALDIE, VA 20105-2324
(703) 332-1863
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0401416546
VA
1223G0001X
General Practice Dentistry
Primary
0401416546
VA
Other
Enumeration date
06/12/2019
Last updated
06/12/2019
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