Provider Demographics
NPI:1679253744
Name:EDEN, KAVEH CHRISTIAN (DMD)
Entity type:Individual
Prefix:DR
First Name:KAVEH
Middle Name:CHRISTIAN
Last Name:EDEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 KING ST STE 300
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2730
Mailing Address - Country:US
Mailing Address - Phone:703-683-6688
Mailing Address - Fax:
Practice Address - Street 1:1500 KING ST STE 300
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2730
Practice Address - Country:US
Practice Address - Phone:703-683-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS044199122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Yes122300000XDental ProvidersDentist