Healthcare Provider Details

I. General information

NPI: 1720134018
Provider Name (Legal Business Name): DR. ZIA SIBTAIN RIZVI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2007
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42882 TRURO PARISH DR SUITE #208
BROADLANDS VA
20148-4456
US

IV. Provider business mailing address

42882 TRURO PARISH DR SUITE #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 Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401410157
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: