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General NPI Number Information
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NPI Number | 1225238017
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Entity Type | Organization
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Legal Business Name | SHAHLA RANJBAR, DMD, PLC
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Dates
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Enumeration Date | 07/20/2007
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Last Update Date | 07/23/2007
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Provider Practice Location Address
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Address Line | 545 E MARKET ST STE G
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City | LEESBURG
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State | VA
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Zip | 20176-4172
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Country | US
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Telephone | 703-669-8688
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2964
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City | LEESBURG
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State | VA
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Zip | 20177-7956
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Country | US
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Telephone | 703-669-8688
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. SHAHLA RANJBAR
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Credential | D.M.D.
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Telephone | 703-669-8688
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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 | VA7845
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License Number State | VA
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