Provider Demographics
NPI:1154597573
Name:FAMILY AND COSMETIC DENTISTRY
Entity type:Organization
Organization Name:FAMILY AND COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NARJES
Authorized Official - Middle Name:
Authorized Official - Last Name:ABTAHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-724-0015
Mailing Address - Street 1:19420 GOLF VISTA PLAZA SUIT # 210
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176
Mailing Address - Country:US
Mailing Address - Phone:703-724-0015
Mailing Address - Fax:703-724-0016
Practice Address - Street 1:19420 GOLF VISTA PLZ STE 210
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-8267
Practice Address - Country:US
Practice Address - Phone:703-724-0015
Practice Address - Fax:703-724-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410795122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty