Provider Demographics
NPI:1629457767
Name:SABA, KIARASH (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIARASH
Middle Name:
Last Name:SABA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47640 PAULSEN SQ
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5193
Mailing Address - Country:US
Mailing Address - Phone:571-348-4090
Mailing Address - Fax:
Practice Address - Street 1:47640 PAULSEN SQ
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-5193
Practice Address - Country:US
Practice Address - Phone:571-348-4090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014145811223G0001X
DCDEN10014471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice