=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225684178
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALI SEENA YAZDANI DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2019
-----------------------------------------------------
Last Update Date | 09/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 349 NORTHUMBERLAND HWY
-----------------------------------------------------
City | CALLAO
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-529-7339
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 349 NORTHUMBERLAND HWY
-----------------------------------------------------
City | CALLAO
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-529-7339
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 0401418302
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------