Provider Demographics
NPI:1417392432
Name:AJANDEH D.D.S PC
Entity Type:Organization
Organization Name:AJANDEH D.D.S PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:AJANDEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-530-9000
Mailing Address - Street 1:9115 ANDREW DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS PARK
Mailing Address - State:VA
Mailing Address - Zip Code:20111-8248
Mailing Address - Country:US
Mailing Address - Phone:703-530-9000
Mailing Address - Fax:703-368-9488
Practice Address - Street 1:9115 ANDREW DR
Practice Address - Street 2:
Practice Address - City:MANASSAS PARK
Practice Address - State:VA
Practice Address - Zip Code:20111-8248
Practice Address - Country:US
Practice Address - Phone:703-530-9000
Practice Address - Fax:703-368-9488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410779122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty