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General NPI Number Information
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NPI Number | 1427925890
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Entity Type | Organization
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Legal Business Name | COSMOSURGE PLLC
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Dates
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Enumeration Date | 10/21/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 2270 VALOR DR STE 105
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City | WINCHESTER
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State | VA
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Zip | 22601-6105
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Country | US
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Telephone | 540-723-7323
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Fax |
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Provider Business Mailing Address
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Address Line | 8816 BARN OWL CT
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City | GAINESVILLE
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State | VA
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Zip | 20155-5917
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Country | US
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Telephone | 301-921-6073
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DALIAH BAZERBASHI
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Credential | DMD
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Telephone | 301-921-6073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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