MEDICARE: MAHEDAVI DENTAL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1063380632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAHEDAVI DENTAL PLLC

Provider Business Mailing Address
First Line	:	20573 MIDDLEBURY ST
Second Line	:
City	:	ASHBURN
State	:	VA
Zip	:	20147-7455
Country	:	US
Telephone Number	:	484-319-9054
Fax Number	:	484-319-9054

Provider Business Practice Location Address
First Line	:	21495 RIDGETOP CIR STE 205
Second Line	:
City	:	STERLING
State	:	VA
Zip	:	20166-6512
Country	:	US
Telephone Number	:	484-319-9054
Fax Number	:	484-319-9054

Authorized Official
Title or Position	:	DENTIST
Name	:	SADIA MAHEDAVI
Credential	:	DDS
Telephone Number	:	484-319-9054

Provider Enumeration Date	:	10/27/2025
Last Update Date	:	02/14/2026

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