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General NPI Number Information
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NPI Number | 1386007516
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Entity Type | Organization
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Legal Business Name | STONE SPRINGS DENTISTRY PLLC
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Dates
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Enumeration Date | 04/04/2016
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Last Update Date | 04/04/2016
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Provider Practice Location Address
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Address Line | 24600 MILLSTREAM DR #480
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City | ALDIE
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State | VA
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Zip | 20105-5685
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Country | US
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Telephone | 703-327-7222
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Fax | 703-995-4454
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Provider Business Mailing Address
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Address Line | 24600 MILLSTREAM DR #480
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City | ALDIE
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State | VA
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Zip | 20105-5685
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Country | US
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Telephone | 703-327-7222
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Fax | 703-995-4454
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Authorized Official
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Title or Position | DENTIST/MANAGER
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Name | DR. NIKTA MARVDASHTI
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Credential | DMD
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Telephone | 703-965-9546
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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 | 0401412374
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License Number State | VA
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