Healthcare Provider Details

I. General information

NPI: 1417886540
Provider Name (Legal Business Name): MRS. SAIRA ELISABETH GARDNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CARPENTER RD FL 2
FORT MYER VA
22211-1009
US

IV. Provider business mailing address

43445 LIVERY SQ
ASHBURN VA
20147-5341
US

V. Phone/Fax

Practice location:
  • Phone: 703-696-3460
  • Fax:
Mailing address:
  • Phone: 832-293-3929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number91092
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: