Organization
SASAN AHMADIYAR, DDS,PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SASAN AHMADIYAR DDS (DENTIST)
(703) 299-1200
Entity
Organization
Contact information
Practice address
1911 BALLENGER AVE, ALEXANDRIA, VA 22314-6819
(703) 299-1200
Mailing address
10608 LEAVELLS RD, FREDERICKSBURG, VA 22407-1256
(540) 710-6000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401008767
VA
1223G0001X
General Practice Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699801787
—
VA
Enumeration date
11/27/2017
Last updated
11/27/2017
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