| NPI | 1497871057 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAMBIZ TAVAKKOLI Doctor 703-494-3176 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401410837) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401410838) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2020-08-22 |