Provider Demographics
NPI:1093048654
Name:ALEXANDRIA DENTAL CENTER, PLLC
Entity Type:Organization
Organization Name:ALEXANDRIA DENTAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIVA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:KERMANSHI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-861-6797
Mailing Address - Street 1:715 PENDLETON ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1820
Mailing Address - Country:US
Mailing Address - Phone:571-970-3783
Mailing Address - Fax:571-970-3827
Practice Address - Street 1:715 PENDLETON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1820
Practice Address - Country:US
Practice Address - Phone:571-970-3783
Practice Address - Fax:571-970-3827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014106381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty