Provider Demographics
NPI:1437288461
Name:NIKKHAH, POURAN (DMD)
Entity Type:Individual
Prefix:
First Name:POURAN
Middle Name:
Last Name:NIKKHAH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 E HOLLY AVE
Mailing Address - Street 2:SUITE #9
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-5405
Mailing Address - Country:US
Mailing Address - Phone:703-430-5700
Mailing Address - Fax:703-935-8018
Practice Address - Street 1:44365 PREMIER PLZ
Practice Address - Street 2:SUITE #230
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5057
Practice Address - Country:US
Practice Address - Phone:703-726-4444
Practice Address - Fax:703-935-8018
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410680122300000X
MDMD12564122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist