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General NPI Number Information
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NPI Number | 1437288461
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Entity Type | Individual
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Provider Name | POURAN NIKKHAH D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 44365 PREMIER PLZ SUITE #230
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City | ASHBURN
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State | VA
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Zip | 20147-5057
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Country | US
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Telephone | 703-726-4444
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Fax | 703-935-8018
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Provider Business Mailing Address
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Address Line | 107 E HOLLY AVE SUITE #9
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City | STERLING
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State | VA
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Zip | 20164-5405
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Country | US
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Telephone | 703-430-5700
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Fax | 703-935-8018
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0401410680
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | MD12564
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License Number State | MD
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