Provider Demographics
NPI:1063567824
Name:BADIPOUR, MANA A (DDS)
Entity type:Individual
Prefix:DR
First Name:MANA
Middle Name:A
Last Name:BADIPOUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8618 WESTWOOD CENTER DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2222
Mailing Address - Country:US
Mailing Address - Phone:703-848-1999
Mailing Address - Fax:
Practice Address - Street 1:8618 WESTWOOD CENTER DR
Practice Address - Street 2:SUITE 109
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2222
Practice Address - Country:US
Practice Address - Phone:703-848-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014103921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice