Healthcare Provider Details

I. General information

NPI: 1659501039
Provider Name (Legal Business Name): SHAHRZAD SALARTASH D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20755 WILLIAMSPORT PL STE 300
ASHBURN VA
20147-6524
US

IV. Provider business mailing address

20755 WILLIAMSPORT PL STE 300
ASHBURN VA
20147-6524
US

V. Phone/Fax

Practice location:
  • Phone: 703-775-0002
  • Fax: 540-900-4747
Mailing address:
  • Phone: 703-775-0002
  • Fax: 540-900-4747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number066988NP
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401412490
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: