Healthcare Provider Details

I. General information

NPI: 1891509725
Provider Name (Legal Business Name): DAVARY & SMITH ORAL & MAXILLOFACIAL SURGERY & DENTAL IMPLANT CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21351 GENTRY DR STE 115
STERLING VA
20166-8510
US

IV. Provider business mailing address

21351 GENTRY DR STE 115
STERLING VA
20166-8510
US

V. Phone/Fax

Practice location:
  • Phone: 703-740-8848
  • Fax:
Mailing address:
  • Phone: 703-740-8848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. ASHKAN DAVARY DOWLATABADY
Title or Position: DENTIST
Credential: MD, DDS
Phone: 703-740-8848