Provider Demographics
NPI:1306961669
Name:YOUSEFZADEH, SHAHIN (DDS)
Entity type:Individual
Prefix:DR
First Name:SHAHIN
Middle Name:
Last Name:YOUSEFZADEH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 N FILLMORE ST
Mailing Address - Street 2:APT 426
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-6701
Mailing Address - Country:US
Mailing Address - Phone:310-210-2786
Mailing Address - Fax:
Practice Address - Street 1:6204 LITTLE RIVER TPKE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-1714
Practice Address - Country:US
Practice Address - Phone:703-658-3000
Practice Address - Fax:703-658-3550
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014133351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice