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General NPI Number Information
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NPI Number | 1487054128
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Entity Type | Organization
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Legal Business Name | ASHBURNFARM DENTAL ARTS
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Dates
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Enumeration Date | 08/31/2014
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Last Update Date | 08/31/2014
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Provider Practice Location Address
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Address Line | 43330 JUNCTION PLAZA SUITE 122
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City | ASHBURN
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State | VA
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Zip | 20147
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Country | US
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Telephone | 703-729-7900
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Fax |
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Provider Business Mailing Address
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Address Line | 43330 JUNCTION PLZ STE 122
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City | ASHBURN
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State | VA
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Zip | 20147-3407
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Country | US
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Telephone | 703-729-7900
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAN D ASHOURIPOUR
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Credential | DDS
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Telephone | 703-625-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 125K00000X
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Taxonomy Name | Advanced Practice Dental Therapist
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License Number | 7312
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License Number State | VA
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