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General NPI Number Information
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NPI Number | 1043678337
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Entity Type | Organization
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Legal Business Name | STERLING FAMILY DENTAL
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Dates
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Enumeration Date | 02/02/2016
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Last Update Date | 02/02/2016
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Provider Practice Location Address
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Address Line | 107 E HOLLY AVE 9
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City | STERLING
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State | VA
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Zip | 20164-5405
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Country | US
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Telephone | 703-430-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 107 E HOLLY AVE 9
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City | STERLING
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State | VA
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Zip | 20164-5405
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Country | US
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Telephone | 703-430-2400
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JASON NIKKHAH
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Credential | D.M.D.
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Telephone | 703-430-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401414653
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License Number State | VA
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