Healthcare Provider Details

I. General information

NPI: 1568021400
Provider Name (Legal Business Name): PAIYAUM BIBIZADEH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7837 ROLLING RD STE B
SPRINGFIELD VA
22153-2821
US

IV. Provider business mailing address

3392 MONARCH LN
ANNANDALE VA
22003-1153
US

V. Phone/Fax

Practice location:
  • Phone: 571-429-4420
  • Fax:
Mailing address:
  • Phone: 571-732-9658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number17018
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401416646
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: