Provider Demographics
NPI:1568683035
Name:HANGVAL, REZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:REZA
Middle Name:
Last Name:HANGVAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10525 BRADDOCK RD
Mailing Address - Street 2:#9A
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-2248
Mailing Address - Country:US
Mailing Address - Phone:703-323-4626
Mailing Address - Fax:703-323-4636
Practice Address - Street 1:10525 BRADDOCK RD
Practice Address - Street 2:#9A
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-2248
Practice Address - Country:US
Practice Address - Phone:703-323-4626
Practice Address - Fax:703-323-4636
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014120471223G0001X
NM18111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice