Provider Demographics
NPI:1689701922
Name:SHARIFZADEH-NADIMI, LILY K (DDS, DMD)
Entity Type:Individual
Prefix:DR
First Name:LILY
Middle Name:K
Last Name:SHARIFZADEH-NADIMI
Suffix:
Gender:F
Credentials:DDS, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8212 OLD COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3821
Mailing Address - Country:US
Mailing Address - Phone:703-848-0971
Mailing Address - Fax:
Practice Address - Street 1:8212 OLD COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3821
Practice Address - Country:US
Practice Address - Phone:703-448-0600
Practice Address - Fax:703-448-0602
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA74291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice