Organization Name: | MAIN STREET FAMILY DENTISTRY PC |
NPI Number: | 1487876538 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ALLEN A ZARRINFAR (PRESIDENT) |
Mailing Address: | 850-d East Main Street Purcellville |
State: | VA US |
Postal Code: | 20132 |
Phone Number: | 5407512221 |
Fax Number: | 5407512218 |
NPI Enumeration Date: | 05/02/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 0401411107 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |