Provider Demographics
NPI:1083866792
Name:SOLTANI, SHAHROKH (DMD)
Entity Type:Individual
Prefix:
First Name:SHAHROKH
Middle Name:
Last Name:SOLTANI
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 1:671 N GLEBE RD STE 1260
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-2137
Mailing Address - Country:US
Mailing Address - Phone:703-294-6144
Mailing Address - Fax:703-294-6147
Practice Address - Street 1:671 NORTH GLEBE ROAD
Practice Address - Street 2:1260
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203
Practice Address - Country:US
Practice Address - Phone:703-294-6144
Practice Address - Fax:703-294-6147
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice