Organization
KAMBIZ AND KAMRAN TAVAKKOLI DMD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAMBIZ TAVAKKOLI DMD (DOCTOR)
(703) 494-3176
Entity
Organization
Contact information
Practice address
12500 LAKE RIDGE DR, WOODBRIDGE, VA 22192-2354
(703) 494-3176
(703) 494-8207
Mailing address
12500 LAKE RIDGE DR, WOODBRIDGE, VA 22192-2354
(703) 494-3176
(703) 494-8207
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401410837
VA
1223G0001X
General Practice Dentistry
0401410838
VA
Other
Enumeration date
03/22/2007
Last updated
08/22/2020
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