Provider Demographics
NPI:1457042442
Name:TOTAL DENTAL ARTS, LLC
Entity Type:Organization
Organization Name:TOTAL DENTAL ARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KOUROSH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZARJANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-890-3200
Mailing Address - Street 1:14631 LEE HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-5827
Mailing Address - Country:US
Mailing Address - Phone:703-890-3200
Mailing Address - Fax:
Practice Address - Street 1:14631 LEE HWY STE 201
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-5827
Practice Address - Country:US
Practice Address - Phone:703-890-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental