Provider Demographics
NPI:1376755744
Name:AHMADIAN, HOSSEIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOSSEIN
Middle Name:
Last Name:AHMADIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 ROOSEVELT BLVD
Mailing Address - Street 2:A519
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-3140
Mailing Address - Country:US
Mailing Address - Phone:443-690-8515
Mailing Address - Fax:
Practice Address - Street 1:503 ROOSEVELT BLVD
Practice Address - Street 2:A519
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-3140
Practice Address - Country:US
Practice Address - Phone:443-690-8515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014110441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice