Provider Demographics
NPI:1760692016
Name:ESTWANI, ISAM B (DDS)
Entity Type:Individual
Prefix:DR
First Name:ISAM
Middle Name:B
Last Name:ESTWANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 ELDEN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4738
Mailing Address - Country:US
Mailing Address - Phone:703-955-4221
Mailing Address - Fax:703-435-7776
Practice Address - Street 1:625 ELDEN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4738
Practice Address - Country:US
Practice Address - Phone:703-955-4221
Practice Address - Fax:703-435-7776
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014100911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice