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General NPI Number Information
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NPI Number | 1700430394
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Entity Type | Organization
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Legal Business Name | ALEXANDRIA DENTAL ART, PLLC
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Dates
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Enumeration Date | 07/31/2019
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Last Update Date | 07/31/2019
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Provider Practice Location Address
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Address Line | 1001 N FAIRFAX ST STE 100
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City | ALEXANDRIA
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State | VA
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Zip | 22314-2084
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Country | US
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Telephone | 703-566-8799
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 N FAIRFAX ST STE 100
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City | ALEXANDRIA
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State | VA
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Zip | 22314-2084
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Country | US
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Telephone | 703-566-8799
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. SHAGHAYEGH MADANI
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Credential | DDS
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Telephone | 703-566-8799
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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 |
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License Number State |
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