MEDICARE: DR. ALI PASHAPOUR DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	0401411854	VA

General Provider Information

NPI Number	:	1124200431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALI PASHAPOUR DMD

Provider Business Mailing Address
First Line	:	3158 GOLANSKY BLVD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-4262
Country	:	US
Telephone Number	:	703-223-2678
Fax Number	:

Provider Business Practice Location Address
First Line	:	1016 N HIGHLAND ST
Second Line	:	STE 131B
City	:	ARLINGTON
State	:	VA
Zip	:	22201-2112
Country	:	US
Telephone Number	:	703-223-2678
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2007
Last Update Date	:	05/20/2021

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