Provider Demographics
NPI:1245376466
Name:AJANDEH, SEAN ABBA (DDS)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:ABBA
Last Name:AJANDEH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:ABBA
Other - Middle Name:S
Other - Last Name:AJANDEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5935 CLAMES DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2657
Mailing Address - Country:US
Mailing Address - Phone:703-944-8203
Mailing Address - Fax:
Practice Address - Street 1:9115 ANDREW DR
Practice Address - Street 2:
Practice Address - City:MANASSAS PARK
Practice Address - State:VA
Practice Address - Zip Code:20111-8248
Practice Address - Country:US
Practice Address - Phone:703-530-9000
Practice Address - Fax:703-367-9488
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice