Provider Demographics
NPI:1629278411
Name:RANJBAR, SHAHLA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHAHLA
Middle Name:
Last Name:RANJBAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SHALA
Other - Middle Name:
Other - Last Name:RANJBAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 2964
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20177-7956
Mailing Address - Country:US
Mailing Address - Phone:703-669-8688
Mailing Address - Fax:
Practice Address - Street 1:545 E MARKET ST STE G
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4172
Practice Address - Country:US
Practice Address - Phone:703-669-8688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA7845122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist