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General NPI Number Information
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NPI Number | 1063762805
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Entity Type | Organization
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Legal Business Name | DRS. CHRISTOPHER & FAVAGEHI
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 313 PARK AVE SUITE 103
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City | FALLS CHURCH
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State | VA
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Zip | 22046-3327
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Country | US
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Telephone | 703-237-3700
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Fax | 703-237-3621
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Provider Business Mailing Address
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Address Line | 313 PARK AVE SUITE 103
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City | FALLS CHURCH
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State | VA
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Zip | 22046-3327
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Country | US
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Telephone | 703-237-3700
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Fax | 703-237-3621
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Authorized Official
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Title or Position | PERIODONTIST
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Name | DR. MEHRDAD FAVAGEHI
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Credential | DDS, M.S.
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Telephone | 703-237-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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