Provider Demographics
NPI:1740532324
Name:NOSRAT, ALI (DDS, MS, MDS)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:NOSRAT
Suffix:
Gender:M
Credentials:DDS, MS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5957 CENTREVILLE CREST LN
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2344
Mailing Address - Country:US
Mailing Address - Phone:703-815-3636
Mailing Address - Fax:
Practice Address - Street 1:5957 CENTREVILLE CREST LN
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2344
Practice Address - Country:US
Practice Address - Phone:703-815-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014149381223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics