Basic Information
| Provider Information | |||||||||
| NPI: | 1780922187 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABBASI-HAFSHEJANI | ||||||||
| FirstName: | AZITA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 46165 WESTLAKE DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | STERLING | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201655872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034449373 | ||||||||
| FaxNumber: | 8474967603 | ||||||||
| Practice Location | |||||||||
| Address1: | 46165 WESTLAKE DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | STERLING | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201655872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034449373 | ||||||||
| FaxNumber: | 8474967603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2013 | ||||||||
| LastUpdateDate: | 11/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 019.029300 | IL | N | Dental Providers | Dentist | 1223X0400X | 0401413845 | VA | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.