Provider Demographics
NPI:1356528327
Name:TYSONS CORNER ADVANCED DENTAL CENTER PC
Entity type:Organization
Organization Name:TYSONS CORNER ADVANCED DENTAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HASAN
Authorized Official - Middle Name:SAMI
Authorized Official - Last Name:OSSEIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS MAGD
Authorized Official - Phone:202-460-2626
Mailing Address - Street 1:8150 LEESBURG PIKE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182
Mailing Address - Country:US
Mailing Address - Phone:703-288-4700
Mailing Address - Fax:703-288-4242
Practice Address - Street 1:8150 LEESBURG PIKE
Practice Address - Street 2:SUITE 900
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182
Practice Address - Country:US
Practice Address - Phone:703-288-4700
Practice Address - Fax:703-288-4242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA81731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty