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General NPI Number Information
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NPI Number | 1417392432
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Entity Type | Organization
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Legal Business Name | AJANDEH D.D.S PC
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Dates
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Enumeration Date | 05/03/2013
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Last Update Date | 05/03/2013
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Provider Practice Location Address
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Address Line | 9115 ANDREW DR
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City | MANASSAS PARK
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State | VA
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Zip | 20111-8248
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Country | US
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Telephone | 703-530-9000
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Fax | 703-368-9488
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Provider Business Mailing Address
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Address Line | 9115 ANDREW DR
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City | MANASSAS PARK
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State | VA
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Zip | 20111-8248
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Country | US
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Telephone | 703-530-9000
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Fax | 703-368-9488
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SEAN A AJANDEH
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Credential | D.D.S
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Telephone | 703-530-9000
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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 | 0401410779
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License Number State | VA
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