Provider Demographics
NPI:1396153375
Name:KARGOLI, SAIF (DDS)
Entity type:Individual
Prefix:
First Name:SAIF
Middle Name:
Last Name:KARGOLI
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 1:100 HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-2645
Mailing Address - Country:US
Mailing Address - Phone:703-214-2113
Mailing Address - Fax:
Practice Address - Street 1:14337 NEWBROOK DR STE 200
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-4259
Practice Address - Country:US
Practice Address - Phone:703-214-2113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1340390200000X
VA04014151751223E0200X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program