Provider Demographics
NPI:1134314115
Name:DANESH, RABI A (DDS)
Entity Type:Individual
Prefix:DR
First Name:RABI
Middle Name:A
Last Name:DANESH
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 1:41987 KUDU CT
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-3418
Mailing Address - Country:US
Mailing Address - Phone:703-348-3324
Mailing Address - Fax:
Practice Address - Street 1:1392 OLD BRIDGE RD
Practice Address - Street 2:LAKE RIDGE
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2708
Practice Address - Country:US
Practice Address - Phone:703-490-9094
Practice Address - Fax:703-490-9096
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410558122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist