Provider Demographics
NPI:1245667922
Name:MINA DADKHAH DDS, PLLC
Entity type:Organization
Organization Name:MINA DADKHAH DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DADKHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-450-2320
Mailing Address - Street 1:1836 PIMMIT DR
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-1105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:46165 WESTLAKE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-5872
Practice Address - Country:US
Practice Address - Phone:650-450-2320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412045261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental