Provider Demographics
NPI:1861672370
Name:ISAM ESTWANI, DDS, INC
Entity Type:Organization
Organization Name:ISAM ESTWANI, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTWANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-955-4221
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental