Healthcare Provider Details

I. General information

NPI: 1063828127
Provider Name (Legal Business Name): DAVID ASGARI DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525C FRONTIER DR
SPRINGFIELD VA
22150-1410
US

IV. Provider business mailing address

6525C FRONTIER DR
SPRINGFIELD VA
22150-1410
US

V. Phone/Fax

Practice location:
  • Phone: 703-313-7000
  • Fax: 703-313-7004
Mailing address:
  • Phone: 703-313-7000
  • Fax: 703-313-7004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401008923
License Number StateVA

VIII. Authorized Official

Name: DR. NAVID ASGARI
Title or Position: PROCTICE OWNER/DENTIST
Credential: D.M.D.
Phone: 703-313-7000