Provider Demographics
NPI:1023162260
Name:SASAN AHMADIYAR, DDS & ASSOCIATES
Entity type:Organization
Organization Name:SASAN AHMADIYAR, DDS & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:BEJARANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-710-6000
Mailing Address - Street 1:10608 LEAVELLS RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-1256
Mailing Address - Country:US
Mailing Address - Phone:540-710-6000
Mailing Address - Fax:540-710-7403
Practice Address - Street 1:10608 LEAVELLS RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-1256
Practice Address - Country:US
Practice Address - Phone:540-710-6000
Practice Address - Fax:540-710-7403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010080831223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty