Provider Demographics
NPI:1609081066
Name:ANOUSHFAR, SHERRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:
Last Name:ANOUSHFAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1984 ISAAC NEWTON SQ W
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5038
Mailing Address - Country:US
Mailing Address - Phone:703-318-8133
Mailing Address - Fax:703-318-8895
Practice Address - Street 1:1984 ISAAC NEWTON SQ W
Practice Address - Street 2:SUITE 201
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5038
Practice Address - Country:US
Practice Address - Phone:703-318-8133
Practice Address - Fax:703-318-8895
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA77281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice