Provider Demographics
NPI:1215091541
Name:SHOHREH SHARIF DDS PC
Entity type:Organization
Organization Name:SHOHREH SHARIF DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST PRESIDENT OF COMPANY
Authorized Official - Prefix:DR
Authorized Official - First Name:SHOHREH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARIF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-620-9122
Mailing Address - Street 1:3700 JOSEPH SIEWICK DRIVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033
Mailing Address - Country:US
Mailing Address - Phone:703-620-9122
Mailing Address - Fax:703-620-6033
Practice Address - Street 1:3700 JOSEPH SIEWICK DRIVE
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033
Practice Address - Country:US
Practice Address - Phone:703-620-9122
Practice Address - Fax:703-620-6033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010078861223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty