| Tysons Modern Dentistry, PC | |
|
8393 Leesburg Pike Vienna VA 22182-2402 | |
| (703) 745-1797 | |
| Not Available |
| Full Name | Tysons Modern Dentistry, PC |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 8393 Leesburg Pike, Vienna, Virginia |
| Authorized Official Name and Position | Ali Shahrestani (OWNER) |
| Authorized Official Contact | 7148458500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tysons Modern Dentistry, PC Po Box 920050 Dallas TX 75392-0050 | Tysons Modern Dentistry, PC 8393 Leesburg Pike Vienna VA 22182-2402 Ph: (703) 745-1797 |
| NPI Number | 1508512708 |
|---|---|
| Provider Enumeration Date | 02/25/2022 |
| Last Update Date | 02/25/2022 |
| Certification Date | 02/25/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508512708 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (NU) | Primary |
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