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General NPI Number Information
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NPI Number | 1356528327
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Entity Type | Organization
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Legal Business Name | TYSONS CORNER ADVANCED DENTAL CENTER PC
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 01/22/2008
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Provider Practice Location Address
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Address Line | 8150 LEESBURG PIKE SUITE 900
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City | VIENNA
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State | VA
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Zip | 22182
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Country | US
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Telephone | 703-288-4700
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Fax | 703-288-4242
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Provider Business Mailing Address
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Address Line | 8150 LEESBURG PIKE SUITE 900
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City | VIENNA
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State | VA
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Zip | 22182
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Country | US
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Telephone | 703-288-4700
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Fax | 703-288-4242
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. HASAN SAMI OSSEIVAN
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Credential | DDS MS MAGD
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Telephone | 202-460-2626
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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 | 8173
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License Number State | VA
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