Provider Demographics
NPI:1699801787
Name:AHMADIYAR, SASAN (DDS)
Entity type:Individual
Prefix:DR
First Name:SASAN
Middle Name:
Last Name:AHMADIYAR
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 1:10608 LEAVELLS RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-1256
Mailing Address - Country:US
Mailing Address - Phone:540-710-6000
Mailing Address - Fax:540-710-7403
Practice Address - Street 1:10608 LEAVELLS RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-1256
Practice Address - Country:US
Practice Address - Phone:540-710-6000
Practice Address - Fax:540-710-7403
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010087671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice