Healthcare Provider Details

I. General information

NPI: 1366935017
Provider Name (Legal Business Name): ANISA KASIRI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANISA MOHAMMAD ISSA

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 12/21/2024
Certification Date: 12/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 COURTHOUSE RD STE 306
CHESTERFIELD VA
23832-6686
US

IV. Provider business mailing address

4106 MEADOWDALE BLVD
NORTH CHESTERFIELD VA
23234-5503
US

V. Phone/Fax

Practice location:
  • Phone: 804-768-7600
  • Fax: 804-768-0115
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401416484
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: