Healthcare Provider Details

I. General information

NPI: 1306202684
Provider Name (Legal Business Name): VERMA & NOSRAT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2016
Last Update Date: 01/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5957 CENTREVILLE CREST LN
CENTREVILLE VA
20121-2344
US

IV. Provider business mailing address

5957 CENTREVILLE CREST LN
CENTREVILLE VA
20121-2344
US

V. Phone/Fax

Practice location:
  • Phone: 703-815-3636
  • Fax:
Mailing address:
  • Phone: 703-815-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number0401413728
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number0401414938
License Number StateVA

VIII. Authorized Official

Name: DR. PRASHANT VERMA
Title or Position: ENDODONTIST
Credential: DDS, MS, FAGD
Phone: 703-815-3636