Provider Demographics
NPI:1356505911
Name:KELISHADI, SEYEDAH (DDS)
Entity Type:Individual
Prefix:
First Name:SEYEDAH
Middle Name:
Last Name:KELISHADI
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 1:11 SMOKEHOUSE DR
Mailing Address - Street 2:STE 115
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-8455
Mailing Address - Country:US
Mailing Address - Phone:540-899-7751
Mailing Address - Fax:540-899-3616
Practice Address - Street 1:11 SMOKEHOUSE DR
Practice Address - Street 2:STE 115
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-8455
Practice Address - Country:US
Practice Address - Phone:540-899-7751
Practice Address - Fax:540-899-3616
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014121811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice