Basic Information
| Provider Information | |||||||||
| NPI: | 1326612334 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE DENTAL OFFICE OF RESTON, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17000 RED HILL AVE | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926145626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148458890 | ||||||||
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| Practice Location | |||||||||
| Address1: | 494 ELDEN ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | HERNDON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201704543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035741716 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2021 | ||||||||
| LastUpdateDate: | 05/14/2021 | ||||||||
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| AuthorizedOfficialLastName: | SHARIFIAN | ||||||||
| AuthorizedOfficialFirstName: | ALEX | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER DENTIST | ||||||||
| AuthorizedOfficialTelephone: | 7148458890 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
| NPICertificationDate: | 05/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.