Provider Demographics
NPI:1184644494
Name:GHANBARI & KOSHKI, DDS PC
Entity Type:Organization
Organization Name:GHANBARI & KOSHKI, DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SPICER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-803-9200
Mailing Address - Street 1:5727 CENTRE SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1916
Mailing Address - Country:US
Mailing Address - Phone:703-803-9200
Mailing Address - Fax:703-803-9419
Practice Address - Street 1:5727 CENTRE SQUARE DR
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-1916
Practice Address - Country:US
Practice Address - Phone:703-803-9200
Practice Address - Fax:703-803-9419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VABG30693481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty