Healthcare Provider Details

I. General information

NPI: 1669936381
Provider Name (Legal Business Name): SALAR EBRAHIMI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2019
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 HARRISON ST SE
LEESBURG VA
20175-3721
US

IV. Provider business mailing address

3406 CARLTON ST
RICHMOND VA
23230-4376
US

V. Phone/Fax

Practice location:
  • Phone: 703-944-6442
  • Fax: 929-266-8885
Mailing address:
  • Phone: 703-944-6442
  • Fax: 929-266-8885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number0401416563
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: