| NPI | 1356819981 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIVA KERMANSHI Owner 703-861-6797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2018-11-13 |