Provider Demographics
NPI:1518575851
Name:REZA TAHERNIA & ASSOCIATES PLLC
Entity Type:Organization
Organization Name:REZA TAHERNIA & ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:CHERI
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-807-0808
Mailing Address - Street 1:1901 N MOORE ST STE 501
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-1700
Mailing Address - Country:US
Mailing Address - Phone:703-807-0808
Mailing Address - Fax:703-807-2652
Practice Address - Street 1:1901 N MOORE ST STE 501
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-1700
Practice Address - Country:US
Practice Address - Phone:703-807-0808
Practice Address - Fax:703-807-2652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty