Provider Demographics
NPI:1174683411
Name:SULTANZADA, YAMA S (DDS)
Entity Type:Individual
Prefix:
First Name:YAMA
Middle Name:S
Last Name:SULTANZADA
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 1:9017 ADVANTAGE CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015
Mailing Address - Country:US
Mailing Address - Phone:703-966-2153
Mailing Address - Fax:703-499-9903
Practice Address - Street 1:2070 OLD BRIDGE RD
Practice Address - Street 2:#201
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192
Practice Address - Country:US
Practice Address - Phone:703-499-9902
Practice Address - Fax:703-499-9903
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014107021223G0001X
DCDEN10002901223G0001X
MD129981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
BS8955342OtherDEA