Organization
LAKERIDGE DENTAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SASAN AHMADIYAR DDS (DENTIST/OWNER)
(540) 710-6000
Entity
Organization
Contact information
Practice address
12506 LAKE RIDGE DR, WOODBRIDGE, VA 22192-2397
(571) 408-4459
Mailing address
12506 LAKE RIDGE DR, WOODBRIDGE, VA 22192-2397
(571) 408-4459
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
0401008767
VA
Other
Enumeration date
06/19/2014
Last updated
06/19/2014
Update your record
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