Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 0401416803 | VA |
NPI | 1003456989 |
---|---|
Provider Name | Dr. Leila Nikpour |
First Address | Centreville, VA 20120-2445 |
Second Address | Warrenton, VA 20186-2047 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2020 |
Last Update Date | 08/01/2020 |