Provider Demographics
NPI:1023152584
Name:NIKSERESHT, KAMRAN (DDS)
Entity type:Individual
Prefix:MR
First Name:KAMRAN
Middle Name:
Last Name:NIKSERESHT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 CENTERVIEW DR.
Mailing Address - Street 2:SUITE Q
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151
Mailing Address - Country:US
Mailing Address - Phone:703-961-0707
Mailing Address - Fax:703-961-0705
Practice Address - Street 1:3901 CENTERVIEW DR.
Practice Address - Street 2:SUITE Q
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151
Practice Address - Country:US
Practice Address - Phone:703-961-0707
Practice Address - Fax:703-961-0705
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010088921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice