Provider Demographics
NPI:1356474894
Name:KERMANSHI, SHIVA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHIVA
Middle Name:
Last Name:KERMANSHI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7186
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-0186
Mailing Address - Country:US
Mailing Address - Phone:703-861-6797
Mailing Address - Fax:703-237-3666
Practice Address - Street 1:6060 ARLINGTON BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2943
Practice Address - Country:US
Practice Address - Phone:703-861-6797
Practice Address - Fax:703-237-3666
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014107901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics