Leesburg Modern Dentistry, PC
Dentist, General Practice in Leesburg, VA. Organization (NPI-2).
NPI number1932837101
StatusActive
Last updated in NPPESAug 15, 2022
Details
- NPI
- 1932837101
- Entity type
- Organization (NPI-2)
- Legal business name
- Leesburg Modern Dentistry, PC
- Organization subpart
- No
- Enumeration date
- Aug 15, 2022
- Certification date
- Aug 15, 2022
- Last updated
- Aug 15, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Other names
- Leesburg Modern Dentistry (Doing Business As)
Practice location
502 E Market StLeesburg, VA 20176-4112
Phone 571-899-4713 · Fax 571-982-7616
Mailing address
Po Box 920050Dallas, TX 75392-0050
Phone 714-845-8890 · Fax 303-952-0892
Authorized official
Ali Shahrestani
Owner Doctor
5718994713
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