| Fairfax Modern Dentistry | |
|
11050 Lee Hwy Fairfax VA 22030-5014 | |
| (703) 520-6376 | |
| Not Available |
| Full Name | Fairfax Modern Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 11050 Lee Hwy, Fairfax, Virginia |
| Authorized Official Name and Position | Ali Shahrestani (OWNER/DMD) |
| Authorized Official Contact | 7035206376 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fairfax Modern Dentistry Po Box 920050 Dallas TX 75392-0050 Ph: (714) 845-8280 | Fairfax Modern Dentistry 11050 Lee Hwy Fairfax VA 22030-5014 Ph: (703) 520-6376 |
| NPI Number | 1174011191 |
|---|---|
| Provider Enumeration Date | 04/25/2018 |
| Last Update Date | 08/05/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174011191 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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