Provider Demographics
NPI:1366935017
Name:KASIRI, ANISA (DDS)
Entity type:Individual
Prefix:DR
First Name:ANISA
Middle Name:
Last Name:KASIRI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANISA
Other - Middle Name:
Other - Last Name:MOHAMMAD ISSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4106 MEADOWDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-5503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9401 COURTHOUSE RD STE 306
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6686
Practice Address - Country:US
Practice Address - Phone:804-768-7600
Practice Address - Fax:804-768-0115
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0401416484122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program