MEDICARE: B TAYLOR KOKABI 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	1223G0001X	General Practice Dentistry	11173	VA

General Provider Information

NPI Number	:	1528100815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	B TAYLOR KOKABI DMD

Provider Business Mailing Address
First Line	:	205 GREENFIELD CT
Second Line	:
City	:	STERLING
State	:	VA
Zip	:	20164-1236
Country	:	US
Telephone Number	:	703-975-1869
Fax Number	:

Provider Business Practice Location Address
First Line	:	8808F PEAR TREE VILLAGE CT
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-4221
Country	:	US
Telephone Number	:	703-780-2400
Fax Number	:	703-780-6099

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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