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General NPI Number Information
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NPI Number | 1245667922
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Entity Type | Organization
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Legal Business Name | MINA DADKHAH DDS, PLLC
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Dates
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Enumeration Date | 09/26/2013
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Last Update Date | 09/26/2013
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Provider Practice Location Address
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Address Line | 46165 WESTLAKE DR SUITE 200
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City | STERLING
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State | VA
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Zip | 20165-5872
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Country | US
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Telephone | 650-450-2320
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Fax |
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Provider Business Mailing Address
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Address Line | 1836 PIMMIT DR
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City | FALLS CHURCH
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State | VA
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Zip | 22043-1105
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MINA DADKHAH
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Credential | DDS
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Telephone | 650-450-2320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 0401412045
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License Number State | VA
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