Healthcare Provider Details

I. General information

NPI: 1295348720
Provider Name (Legal Business Name): VIRGINIA PLASTIC SURGERY INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
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

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

V. Phone/Fax

Practice location:
  • Phone: 703-566-1990
  • Fax: 703-997-7310
Mailing address:
  • Phone: 703-566-1990
  • Fax: 703-997-7310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ALI Z PASHAPOUR
Title or Position: PRESIDENT
Credential:
Phone: 703-566-1990