Healthcare Provider Details

I. General information

NPI: 1497626121
Provider Name (Legal Business Name): CALLAO FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 NORTHUMBERLAND HWY
CALLAO VA
22435
US

IV. Provider business mailing address

349 NORTHUMBERLAND HWY
CALLAO VA
22435
US

V. Phone/Fax

Practice location:
  • Phone: 804-529-7339
  • Fax:
Mailing address:
  • Phone: 804-529-7339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. ALI SEENA YAZDANI
Title or Position: DENTIST
Credential: DDS
Phone: 571-354-5115