Provider Demographics
NPI:1366631400
Name:ZADEH, DAVOUD (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVOUD
Middle Name:
Last Name:ZADEH
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 1:611 S CARLIN SPRINGS RD
Mailing Address - Street 2:#408
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1064
Mailing Address - Country:US
Mailing Address - Phone:703-671-7500
Mailing Address - Fax:703-671-7607
Practice Address - Street 1:611 S CARLIN SPRINGS RD
Practice Address - Street 2:#408
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1064
Practice Address - Country:US
Practice Address - Phone:703-671-7500
Practice Address - Fax:703-671-7607
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008675122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist