Healthcare Provider Details

I. General information

NPI: 1578792065
Provider Name (Legal Business Name): SHERVIN TABESHFAR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44084 RIVERSIDE PKWY STE 340
LEESBURG VA
20176-5102
US

IV. Provider business mailing address

44084 RIVERSIDE PKWY STE 340
LEESBURG VA
20176-5102
US

V. Phone/Fax

Practice location:
  • Phone: 571-617-6465
  • Fax:
Mailing address:
  • Phone: 571-617-6465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401415140
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: