Provider Demographics
NPI:1659501039
Name:SALARTASH, SHAHRZAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAHRZAD
Middle Name:
Last Name:SALARTASH
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 1:20755 WILLIAMSPORT PL STE 300
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-6524
Mailing Address - Country:US
Mailing Address - Phone:703-775-0002
Mailing Address - Fax:540-900-4747
Practice Address - Street 1:3116 MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22305-2639
Practice Address - Country:US
Practice Address - Phone:703-745-5496
Practice Address - Fax:703-468-0180
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014124901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice