Provider Demographics
NPI:1699967562
Name:AHMADZADA, ZIA (DMD)
Entity type:Individual
Prefix:DR
First Name:ZIA
Middle Name:
Last Name:AHMADZADA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4604D PINECREST OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1441
Mailing Address - Country:US
Mailing Address - Phone:703-658-9600
Mailing Address - Fax:703-658-9619
Practice Address - Street 1:4604D PINECREST OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-1441
Practice Address - Country:US
Practice Address - Phone:703-658-9600
Practice Address - Fax:703-658-9619
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014106391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice