Provider Demographics
NPI:1487054128
Name:ASHBURNFARM DENTAL ARTS
Entity type:Organization
Organization Name:ASHBURNFARM DENTAL ARTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ASHOURIPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-625-6800
Mailing Address - Street 1:43330 JUNCTION PLZ STE 122
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3407
Mailing Address - Country:US
Mailing Address - Phone:703-729-7900
Mailing Address - Fax:
Practice Address - Street 1:43330 JUNCTION PLAZA SUITE 122
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147
Practice Address - Country:US
Practice Address - Phone:703-729-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANDMARK SMILE DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-31
Last Update Date:2014-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA7312125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes125K00000XDental ProvidersAdvanced Practice Dental TherapistGroup - Single Specialty