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General NPI Number Information
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NPI Number | 1174683411
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Entity Type | Individual
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Provider Name | YAMA S SULTANZADA DDS
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Gender | Male
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Dates
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Enumeration Date | 12/09/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2070 OLD BRIDGE RD #201
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City | WOODBRIDGE
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State | VA
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Zip | 22192
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Country | US
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Telephone | 703-499-9902
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Fax | 703-499-9903
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Provider Business Mailing Address
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Address Line | 9017 ADVANTAGE CT
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City | BURKE
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State | VA
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Zip | 22015
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Country | US
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Telephone | 703-966-2153
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Fax | 703-499-9903
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0401410702
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN1000290
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12998
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License Number State | MD
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