Provider Demographics
NPI:1467720078
Name:ARTISTE DENTISTRY LLC
Entity Type:Organization
Organization Name:ARTISTE DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHIRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-434-3286
Mailing Address - Street 1:46090 LAKE CENTER PLZ
Mailing Address - Street 2:SUITE 107
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5876
Mailing Address - Country:US
Mailing Address - Phone:703-434-3286
Mailing Address - Fax:
Practice Address - Street 1:46090 LAKE CENTER PLZ
Practice Address - Street 2:SUITE 107
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-5876
Practice Address - Country:US
Practice Address - Phone:703-434-3286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410136122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty