| NPI | 1174011191 |
|---|---|
| Doing Business As | FAIRFAX MODERN DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | ALI SHAHRESTANI Owner/Dmd 703-520-6376 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2022-08-05 |