Healthcare Provider Details

I. General information

NPI: 1932584687
Provider Name (Legal Business Name): PREMIER DENTAL CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2579 JOHN MILTON DR STE 250
OAK HILL VA
20171-2500
US

IV. Provider business mailing address

2579 JOHN MILTON DR STE 250
OAK HILL VA
20171-2500
US

V. Phone/Fax

Practice location:
  • Phone: 703-860-8860
  • Fax:
Mailing address:
  • Phone: 703-860-8860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401411993
License Number StateVA

VIII. Authorized Official

Name: DR. FARSHAD BAKHTYARI
Title or Position: OWNER
Credential:
Phone: 703-860-8860