Provider Demographics
NPI:1194911040
Name:RESTON FAMILY & COSMETIC DENTISTRY
Entity type:Organization
Organization Name:RESTON FAMILY & COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:NESHAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-437-5555
Mailing Address - Street 1:1984 ISAAC NEWTON SQ W STE 100
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5039
Mailing Address - Country:US
Mailing Address - Phone:703-437-5555
Mailing Address - Fax:703-437-8584
Practice Address - Street 1:1984 ISAAC NEWTON SQ W STE 100
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5039
Practice Address - Country:US
Practice Address - Phone:703-437-5555
Practice Address - Fax:703-437-8584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014107271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty