Provider Demographics
NPI:1457369779
Name:JARVANDI, FERESHTEH (DDS)
Entity Type:Individual
Prefix:DR
First Name:FERESHTEH
Middle Name:
Last Name:JARVANDI
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 1:4712 JEFFERSON DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23234
Mailing Address - Country:US
Mailing Address - Phone:804-271-9828
Mailing Address - Fax:804-271-6969
Practice Address - Street 1:4712 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23234
Practice Address - Country:US
Practice Address - Phone:804-271-9828
Practice Address - Fax:804-271-6969
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007591122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007816103Medicaid
VA143930OtherANTHEM
832506OtherUCCI