Healthcare Provider Details

I. General information

NPI: 1790187516
Provider Name (Legal Business Name): NAVID ASGARI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N FAIRFAX ST STE 100
ALEXANDRIA VA
22314-1798
US

IV. Provider business mailing address

1001 N FAIRFAX ST STE 100
ALEXANDRIA VA
22314-1798
US

V. Phone/Fax

Practice location:
  • Phone: 703-566-8799
  • Fax: 703-313-7004
Mailing address:
  • Phone: 703-566-8799
  • Fax: 703-313-7004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401410470
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401413354
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number0401413982
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0438000159
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401411446
License Number StateVA
# 6
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401008923
License Number StateVA

VIII. Authorized Official

Name: DR. NAVI AMIN ASGARI
Title or Position: PRACTICE OWNER
Credential: D.M.D., P.C.
Phone: 703-556-8799