Healthcare Provider Details

I. General information

NPI: 1417206368
Provider Name (Legal Business Name): MARYAM SULTANA AHMED D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 PIDGEON HILL DR STE 103
STERLING VA
20165-6180
US

IV. Provider business mailing address

41382 RASPBERRY DR
LEESBURG VA
20176-7826
US

V. Phone/Fax

Practice location:
  • Phone: 703-651-6620
  • Fax:
Mailing address:
  • Phone: 440-281-2960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number4381
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401416061
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401416061
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: