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General NPI Number Information
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NPI Number | 1366864316
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Entity Type | Organization
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Legal Business Name | MATT NIKPOURFARD DDS PC
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Dates
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Enumeration Date | 01/10/2014
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Last Update Date | 01/10/2014
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Provider Practice Location Address
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Address Line | 44121 HARRY BYRD HWY SUITE 280
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City | ASHBURN
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State | VA
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Zip | 20147-5667
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Country | US
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Telephone | 703-723-1200
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Fax | 703-723-7027
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Provider Business Mailing Address
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Address Line | 44121 HARRY BYRD HWY SUITE 280
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City | ASHBURN
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State | VA
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Zip | 20147-5667
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Country | US
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Telephone | 703-723-1200
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Fax | 703-723-7027
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Authorized Official
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Title or Position | DDS
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Name | MATT NIKPOURFARD
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Credential |
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Telephone | 703-723-1200
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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 | 401410566
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License Number State | VA
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