Healthcare Provider Details

I. General information

NPI: 1760804389
Provider Name (Legal Business Name): ACDG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2014
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 CLARENDON BLVD
ARLINGTON VA
22209-2741
US

IV. Provider business mailing address

1731 CLARENDON BLVD
ARLINGTON VA
22209-2741
US

V. Phone/Fax

Practice location:
  • Phone: 703-812-8800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIAH SHOJAEI
Title or Position: OWNER
Credential: DMD
Phone: 703-812-8800