| NPI | 1770591695 |
|---|---|
| Other Name | TYSONS DENTAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | FARIDEM IRAVANI Dentist/Provider/Owner 703-848-8448 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401008961) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2020-08-22 |