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General NPI Number Information
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NPI Number | 1902654882
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Entity Type | Organization
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Legal Business Name | INOVA DENTAL CLINIC
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Dates
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Enumeration Date | 05/07/2024
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 21495 RIDGETOP CIR STE 303
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City | STERLING
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State | VA
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Zip | 20166-6512
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Country | US
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Telephone | 703-433-1400
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Fax | 571-434-0994
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Provider Business Mailing Address
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Address Line | 21495 RIDGETOP CIR STE 303
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City | STERLING
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State | VA
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Zip | 20166-6512
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Country | US
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Telephone | 703-433-1400
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Fax | 571-434-0994
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Authorized Official
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Title or Position | DENTIST
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Name | MAHNAZ JAFARI
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Credential |
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Telephone | 703-554-2744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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