Provider Demographics
NPI:1881075893
Name:AFLATOONI, POOYA (DDS)
Entity type:Individual
Prefix:DR
First Name:POOYA
Middle Name:
Last Name:AFLATOONI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7978 CRESCENT PARK DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-1562
Mailing Address - Country:US
Mailing Address - Phone:571-620-6200
Mailing Address - Fax:
Practice Address - Street 1:43170 SOUTHERN WALK PLZ STE 116
Practice Address - Street 2:
Practice Address - City:BROADLANDS
Practice Address - State:VA
Practice Address - Zip Code:20148-4464
Practice Address - Country:US
Practice Address - Phone:703-984-9026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014148471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice