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General NPI Number Information
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NPI Number | 1154597573
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Entity Type | Organization
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Legal Business Name | FAMILY AND COSMETIC DENTISTRY
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 19420 GOLF VISTA PLZ STE 210
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City | LEESBURG
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State | VA
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Zip | 20176-8267
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Country | US
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Telephone | 703-724-0015
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Fax | 703-724-0016
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Provider Business Mailing Address
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Address Line | 19420 GOLF VISTA PLAZA SUIT # 210
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City | LEESBURG
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State | VA
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Zip | 20176
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Country | US
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Telephone | 703-724-0015
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Fax | 703-724-0016
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Authorized Official
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Title or Position | DENTIST
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Name | DR. NARJES ABTAHI
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Credential |
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Telephone | 703-724-0015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401410795
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License Number State | VA
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