Individual
MICHAEL EGHTESSAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
44330 PREMIER PLZ STE 140, ASHBURN, VA 20147-5071
(703) 726-0333
(703) 726-0553
Mailing address
44330 PREMIER PLZ STE 140, ASHBURN, VA 20147-5071
(703) 726-0333
(703) 726-0553
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401410302
VA
Other
Enumeration date
01/02/2007
Last updated
11/11/2014
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