Provider Demographics
NPI:1235551508
Name:HASHEM SEDAGHATPOUR D.M.D. P.C.
Entity Type:Organization
Organization Name:HASHEM SEDAGHATPOUR D.M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HASHEM
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDAGHATPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-250-5790
Mailing Address - Street 1:5631 BURKE CENTRE PKWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2234
Mailing Address - Country:US
Mailing Address - Phone:703-250-5790
Mailing Address - Fax:703-250-2935
Practice Address - Street 1:5631 BURKE CENTRE PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-2234
Practice Address - Country:US
Practice Address - Phone:703-250-5790
Practice Address - Fax:703-250-2935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty