Healthcare Provider Details

I. General information

NPI: 1710308051
Provider Name (Legal Business Name): ZIA RIZVI DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2014
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42882 TRURO PARISH DR 208
BROADLANDS VA
20148-4456
US

IV. Provider business mailing address

42882 TRURO PARISH DR 208
BROADLANDS VA
20148-4456
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-1904
  • Fax: 703-858-0840
Mailing address:
  • Phone: 703-858-1904
  • Fax: 703-858-0840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401410157
License Number StateVA

VIII. Authorized Official

Name: ZIA RIZVI
Title or Position: DENTIST
Credential: DDS
Phone: 703-858-1904