Provider Demographics
NPI:1366096273
Name:SAREEN, NATASHA
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:SAREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 BARNESDALE PATH
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-3901
Mailing Address - Country:US
Mailing Address - Phone:703-314-4497
Mailing Address - Fax:
Practice Address - Street 1:205 STEEPLE CHASE DR STE 208
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4056
Practice Address - Country:US
Practice Address - Phone:410-705-0962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014165821223G0001X
MD170151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice