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General NPI Number Information
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NPI Number | 1093048654
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Entity Type | Organization
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Legal Business Name | ALEXANDRIA DENTAL CENTER, PLLC
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Dates
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Enumeration Date | 09/15/2009
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Last Update Date | 09/15/2009
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Provider Practice Location Address
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Address Line | 715 PENDLETON ST
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City | ALEXANDRIA
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State | VA
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Zip | 22314-1820
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Country | US
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Telephone | 571-970-3783
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Fax | 571-970-3827
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Provider Business Mailing Address
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Address Line | 715 PENDLETON ST
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City | ALEXANDRIA
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State | VA
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Zip | 22314-1820
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Country | US
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Telephone | 571-970-3783
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Fax | 571-970-3827
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. SHIVA Y KERMANSHI
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Credential | DMD
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Telephone | 703-861-6797
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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 | 0401410638
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License Number State | VA
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