Provider Demographics
NPI:1326348350
Name:VIRGINA FAMILY AND COSMETIC DENTISTRY INC
Entity Type:Organization
Organization Name:VIRGINA FAMILY AND COSMETIC DENTISTRY INC
Other - Org Name:RESTON TOWN CENTER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GHOLAMALI
Authorized Official - Middle Name:
Authorized Official - Last Name:MIAMEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-863-3255
Mailing Address - Street 1:1760 RESTON PKWY STE 415
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3360
Mailing Address - Country:US
Mailing Address - Phone:703-956-9444
Mailing Address - Fax:
Practice Address - Street 1:1760 RESTON PKWY STE 415
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3360
Practice Address - Country:US
Practice Address - Phone:703-956-9444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRGINA FAMILY AND COSMETIC DENTISTRY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty