Healthcare Provider Details

I. General information

NPI: 1023666104
Provider Name (Legal Business Name): MIRZA SHAYAN BAIG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SHAYAN BAIG DDS

II. Dates (important events)

Enumeration Date: 08/31/2019
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 E MAIN ST STE P
PURCELLVILLE VA
20132-3182
US

IV. Provider business mailing address

609 E MAIN ST STE P
PURCELLVILLE VA
20132-3182
US

V. Phone/Fax

Practice location:
  • Phone: 540-900-0970
  • Fax:
Mailing address:
  • Phone: 540-900-0970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0401419920
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: