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General NPI Number Information
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NPI Number | 1356819981
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Entity Type | Organization
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Legal Business Name | NOVICARE ORTHODONTICS PLLC
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Dates
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Enumeration Date | 11/13/2018
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Last Update Date | 11/13/2018
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Provider Practice Location Address
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Address Line | 717 PENDLETON ST
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City | ALEXANDRIA
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State | VA
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Zip | 22314-1820
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Country | US
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Telephone | 571-970-3801
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Fax | 571-970-3827
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Provider Business Mailing Address
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Address Line | 717 PENDLETON ST
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City | ALEXANDRIA
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State | VA
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Zip | 22314-1820
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Country | US
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Telephone | 571-970-3801
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Fax | 571-970-3827
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Authorized Official
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Title or Position | OWNER
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Name | SHIVA KERMANSHI
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Credential | DMD
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Telephone | 703-861-6797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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