Provider Demographics
NPI:1366864316
Name:MATT NIKPOURFARD DDS PC
Entity Type:Organization
Organization Name:MATT NIKPOURFARD DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKPOURFARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-723-1200
Mailing Address - Street 1:44121 HARRY BYRD HWY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5667
Mailing Address - Country:US
Mailing Address - Phone:703-723-1200
Mailing Address - Fax:703-723-7027
Practice Address - Street 1:44121 HARRY BYRD HWY
Practice Address - Street 2:SUITE 280
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5667
Practice Address - Country:US
Practice Address - Phone:703-723-1200
Practice Address - Fax:703-723-7027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA401410566122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty