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General NPI Number Information
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NPI Number | 1801275995
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Entity Type | Individual
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Provider Name | ASHKAN DAVARY DOWLATABADY MD, DDS
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Gender | Male
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Dates
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Enumeration Date | 05/22/2015
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Last Update Date | 06/22/2021
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Provider Practice Location Address
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Address Line | 11050 LEE HWY
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City | FAIRFAX
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State | VA
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Zip | 22030-5014
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Country | US
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Telephone | 949-338-8291
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Fax |
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Provider Business Mailing Address
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Address Line | 7755 LEGERE CT
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City | MC LEAN
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State | VA
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Zip | 22102-4790
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Country | US
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Telephone | 949-338-8291
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Fax |
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0401417276
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 17298
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License Number State | MD
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