Provider Demographics
NPI:1396538377
Name:MARYAM AVIN DDS PC
Entity type:Organization
Organization Name:MARYAM AVIN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-687-3255
Mailing Address - Street 1:19366 DIAMOND LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6574
Mailing Address - Country:US
Mailing Address - Phone:703-687-3255
Mailing Address - Fax:703-687-3246
Practice Address - Street 1:19366 DIAMOND LAKE DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-6574
Practice Address - Country:US
Practice Address - Phone:703-687-3255
Practice Address - Fax:703-687-3246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-23
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental