Healthcare Provider Details

I. General information

NPI: 1124200431
Provider Name (Legal Business Name): ALI PASHAPOUR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 N HIGHLAND ST STE 131B
ARLINGTON VA
22201-2112
US

IV. Provider business mailing address

3158 GOLANSKY BLVD
WOODBRIDGE VA
22192-4262
US

V. Phone/Fax

Practice location:
  • Phone: 703-223-2678
  • Fax:
Mailing address:
  • Phone: 703-223-2678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401411854
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: