Provider Demographics
NPI:1386007516
Name:STONE SPRINGS DENTISTRY PLLC
Entity type:Organization
Organization Name:STONE SPRINGS DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARVDASHTI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-965-9546
Mailing Address - Street 1:24600 MILLSTREAM DR
Mailing Address - Street 2:#480
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-5685
Mailing Address - Country:US
Mailing Address - Phone:703-327-7222
Mailing Address - Fax:703-995-4454
Practice Address - Street 1:24600 MILLSTREAM DR
Practice Address - Street 2:#480
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-5685
Practice Address - Country:US
Practice Address - Phone:703-327-7222
Practice Address - Fax:703-995-4454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412374122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty