Provider Demographics
NPI:1881182814
Name:ASHBURN DENTAL STUDIO PLLC
Entity Type:Organization
Organization Name:ASHBURN DENTAL STUDIO PLLC
Other - Org Name:ASHBURN DENTAL STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SAHIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORTAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:347-761-7199
Mailing Address - Street 1:43480 YUKON DR STE 204
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-6988
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:43480 YUKON DR STE 204
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6988
Practice Address - Country:US
Practice Address - Phone:703-729-8277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-25
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental