Provider Demographics
NPI:1326025263
Name:DANESHVAR, AREZOU M (DDS)
Entity Type:Individual
Prefix:
First Name:AREZOU
Middle Name:M
Last Name:DANESHVAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 S. KING STREET
Mailing Address - Street 2:SUITE E
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175
Mailing Address - Country:US
Mailing Address - Phone:571-363-2244
Mailing Address - Fax:571-363-2255
Practice Address - Street 1:821 S KING ST
Practice Address - Street 2:SUITE E
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3921
Practice Address - Country:US
Practice Address - Phone:571-363-2244
Practice Address - Fax:571-363-2255
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014124331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2581513Medicaid
PA1011894020001Medicaid