Provider Demographics
NPI:1932584687
Name:PREMIER DENTAL CARE, PC
Entity Type:Organization
Organization Name:PREMIER DENTAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARSHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKHTYARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-860-8860
Mailing Address - Street 1:2579 JOHN MILTON DR STE 250
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2500
Mailing Address - Country:US
Mailing Address - Phone:703-860-8860
Mailing Address - Fax:
Practice Address - Street 1:2579 JOHN MILTON DR STE 250
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:VA
Practice Address - Zip Code:20171-2500
Practice Address - Country:US
Practice Address - Phone:703-860-8860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014119931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty