Provider Demographics
NPI:1982814489
Name:KAZEROONI, SHOHREH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHOHREH
Middle Name:
Last Name:KAZEROONI
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 1:8347 GREENSBORO DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102
Mailing Address - Country:US
Mailing Address - Phone:703-827-0644
Mailing Address - Fax:
Practice Address - Street 1:8347 GREENSBORO DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22102
Practice Address - Country:US
Practice Address - Phone:703-827-0644
Practice Address - Fax:
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
VA04010086071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice