Provider Demographics
NPI:1417274747
Name:ALIREZA SHARAFI DDS, PLLC
Entity Type:Organization
Organization Name:ALIREZA SHARAFI DDS, PLLC
Other - Org Name:SMILEVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARAFI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-417-9722
Mailing Address - Street 1:6437 ROCKSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-3436
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6354 WALKER LN
Practice Address - Street 2:SUITE 103
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3229
Practice Address - Country:US
Practice Address - Phone:703-417-9722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412044261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental