Provider Demographics
NPI:1760675797
Name:SHAHRAM SABET DDS, PC
Entity Type:Organization
Organization Name:SHAHRAM SABET DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SABET
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-281-1311
Mailing Address - Street 1:360 MAPLE AVE W STE C
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-5614
Mailing Address - Country:US
Mailing Address - Phone:703-281-1311
Mailing Address - Fax:
Practice Address - Street 1:360 MAPLE AVE W STE C
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-5614
Practice Address - Country:US
Practice Address - Phone:703-281-1311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410366122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty