Skip Navigation

Provider Information for 1710044623



MICHAEL EGHTESSAD

Gender: MALE

Individual NPI: 1710044623

Calendar Last Updated: 2014-11-11

Details

Name Value
NPI 1710044623
Enumeration Date 2007-01-02
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 44330 PREMIER PLZ STE 140
ASHBURN, VA 20147-5071
United States

Phone: 703-726-0333 | Fax: 703-726-0553
View Map External Link
Primary Practice Address 44330 PREMIER PLZ STE 140
ASHBURN, VA 20147-5071
United States

Phone: 703-726-0333 | Fax: 703-726-0553
View Map External Link
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice VA 0401410302
Other Identifiers
Issuer State Number
Endpoint Information
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location