Provider Demographics
NPI:1952872285
Name:ONE LOUDOUN DENTAL LLC
Entity type:Organization
Organization Name:ONE LOUDOUN DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARIUOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHOURIPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-625-6800
Mailing Address - Street 1:44790 MAYNARD SQ STE 180
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-6515
Mailing Address - Country:US
Mailing Address - Phone:703-729-7900
Mailing Address - Fax:703-729-3085
Practice Address - Street 1:44790 MAYNARD SQ STE 180
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6515
Practice Address - Country:US
Practice Address - Phone:703-729-7900
Practice Address - Fax:703-729-3085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental