Provider Demographics
NPI:1770856015
Name:NAMBOODIRI, ARYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARYA
Middle Name:
Last Name:NAMBOODIRI
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 1:1466B N BEAUREGARD ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-5800
Mailing Address - Country:US
Mailing Address - Phone:703-778-1221
Mailing Address - Fax:
Practice Address - Street 1:1466B N BEAUREGARD ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-5800
Practice Address - Country:US
Practice Address - Phone:703-778-1221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014140981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice