Provider Demographics
NPI:1922347053
Name:AJINEH, SEIREN (DDS)
Entity Type:Individual
Prefix:
First Name:SEIREN
Middle Name:
Last Name:AJINEH
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 1:1881 N NASH ST UNIT 1504
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-1569
Mailing Address - Country:US
Mailing Address - Phone:401-588-4924
Mailing Address - Fax:
Practice Address - Street 1:12100 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-6908
Practice Address - Country:US
Practice Address - Phone:757-234-7572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-08
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6993-15122300000X
VA04014145931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist