Provider Demographics
NPI:1295896892
Name:TAJALLI, FLORA B (DDS)
Entity type:Individual
Prefix:DR
First Name:FLORA
Middle Name:B
Last Name:TAJALLI
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 1:209 ELDEN ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4852
Mailing Address - Country:US
Mailing Address - Phone:703-709-0102
Mailing Address - Fax:703-709-6916
Practice Address - Street 1:209 ELDEN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4852
Practice Address - Country:US
Practice Address - Phone:703-709-0102
Practice Address - Fax:703-709-6916
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010086391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice