Healthcare Provider Details

I. General information

NPI: 1396153375
Provider Name (Legal Business Name): SAIF KARGOLI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14337 NEWBROOK DR STE 200
CHANTILLY VA
20151-4259
US

IV. Provider business mailing address

100 HAVEN AVE
NEW YORK NY
10032-2645
US

V. Phone/Fax

Practice location:
  • Phone: 703-214-2113
  • Fax:
Mailing address:
  • Phone: 703-214-2113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1340
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0401415175
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: