MEDICARE: PASHAPOUR ORAL PLUS FACIAL SURGERY

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	261QD0000X	Dental Clinic/Center	0401411854	VA

General Provider Information

NPI Number	:	1376886564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASHAPOUR ORAL PLUS FACIAL SURGERY

Provider Business Mailing Address
First Line	:	1016 N HIGHLAND ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22201-2112
Country	:	US
Telephone Number	:	703-566-1990
Fax Number	:

Provider Business Practice Location Address
First Line	:	1016 N HIGHLAND ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22201-2112
Country	:	US
Telephone Number	:	703-566-1990
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALI PASHAPOUR
Credential	:	DMD
Telephone Number	:	703-566-1990

Provider Enumeration Date	:	04/05/2013
Last Update Date	:	04/05/2013

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