Bastani, Nickie Rose

Bastani, Nickie Rose is an individual health care provider with primary practice located at 3700 Joseph Siewick Dr Ste 104 , Fairfax VA 22033-1737. She recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Pediatric Dentistry. Dental Providers / Pediatric Dentistry is her primary health care specialty. Bastani, Nickie Rose can be contacted via phone (703) 620-9122.

Contact Information

Primary practice address
3700 Joseph Siewick Dr Ste 104 Fairfax VA 22033-1737
Phone: (703) 620-9122
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 2901020839 Michigan
Dental Providers / Pediatric Dentistry 1223P0221X 2901020839 Michigan

Profile Details

NPI number 1801140892
LBN Legal business name Bastani, Nickie Rose
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 30th, 2012
Last updated Jan 21st, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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