Healthcare Provider Details

I. General information

NPI: 1376204388
Provider Name (Legal Business Name): ZOOGY DENTAL COMPANY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 HERITAGE VILLAGE PLZ STE 101
GAINESVILLE VA
20155-3068
US

IV. Provider business mailing address

7120 HERITAGE VILLAGE PLZ STE 101
GAINESVILLE VA
20155-3068
US

V. Phone/Fax

Practice location:
  • Phone: 703-349-0099
  • Fax:
Mailing address:
  • Phone: 703-349-0099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. ZAN PERVAIZ
Title or Position: OWNER
Credential: DDS
Phone: 703-349-0099