Provider Demographics
NPI:1679631980
Name:NADER REZVANI D.D.S., P.C.
Entity Type:Organization
Organization Name:NADER REZVANI D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NADER
Authorized Official - Middle Name:
Authorized Official - Last Name:REZVANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-457-0070
Mailing Address - Street 1:908 NEW HAMPSHIRE AVE NW
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2346
Mailing Address - Country:US
Mailing Address - Phone:202-457-0070
Mailing Address - Fax:202-457-0029
Practice Address - Street 1:908 NEW HAMPSHIRE AVE NW
Practice Address - Street 2:SUITE 301
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2346
Practice Address - Country:US
Practice Address - Phone:202-457-0070
Practice Address - Fax:202-457-0029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN46361223G0001X
VA04010085271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty