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General NPI Number Information
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NPI Number | 1366937096
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Entity Type | Organization
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Legal Business Name | ROXANNE AZMOUDEH, D.D.S. P. C.
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 44355 PREMIER PLZ STE 100
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City | ASHBURN
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State | VA
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Zip | 20147-5050
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Country | US
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Telephone | 703-858-9146
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Fax | 703-858-9147
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Provider Business Mailing Address
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Address Line | 44355 PREMIER PLZ STE 100
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City | ASHBURN
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State | VA
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Zip | 20147-5050
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Country | US
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Telephone | 703-858-9146
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Fax | 703-858-9147
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROXANNE AZMOUDEH
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Credential | DDS
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Telephone | 703-858-9146
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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 | 0401410979
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License Number State | VA
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