Healthcare Provider Details

I. General information

NPI: 1225030893
Provider Name (Legal Business Name): RASHIN T BIDGOLI DMD, PC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21145 WHITFIELD PL SUITE #101
STERLING VA
20165-7282
US

IV. Provider business mailing address

21145 WHITFIELD PL SUITE #101
STERLING VA
20165-7282
US

V. Phone/Fax

Practice location:
  • Phone: 703-444-4229
  • Fax: 703-444-9118
Mailing address:
  • Phone: 703-444-4229
  • Fax: 703-444-9118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0401410313
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: