Provider Demographics
NPI:1568635225
Name:NIKKHAH, PLC
Entity type:Organization
Organization Name:NIKKHAH, PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:POURAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKKHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR
Authorized Official - Phone:703-430-5700
Mailing Address - Street 1:44365 PREMIER PLZ
Mailing Address - Street 2:SUITE #230
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5057
Mailing Address - Country:US
Mailing Address - Phone:703-726-4444
Mailing Address - Fax:703-935-8018
Practice Address - Street 1:44365 PREMIER PLZ
Practice Address - Street 2:SUITE #230
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5057
Practice Address - Country:US
Practice Address - Phone:703-726-4444
Practice Address - Fax:703-935-8018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410680122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty