| NPI | 1467720078 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA MOSHIRI Owner 703-434-3286 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401410136) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: VA 0401410136) |
| Enumeration Date | 2011-12-09 |
| Last Update Date | 2011-12-09 |