MEDICARE: DR. RASHIN T BIDGOLI DMD, PC

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	1223E0200X	Endodontics	0401410313	VA

General Provider Information

NPI Number	:	1225030893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RASHIN T BIDGOLI DMD, PC

Provider Business Mailing Address
First Line	:	21145 WHITFIELD PL
Second Line	:	SUITE #101
City	:	STERLING
State	:	VA
Zip	:	20165-7282
Country	:	US
Telephone Number	:	703-444-4229
Fax Number	:	703-444-9118

Provider Business Practice Location Address
First Line	:	21145 WHITFIELD PL
Second Line	:	SUITE #101
City	:	STERLING
State	:	VA
Zip	:	20165-7282
Country	:	US
Telephone Number	:	703-444-4229
Fax Number	:	703-444-9118

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	07/08/2007

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