Nickie Rose Bastani, DDS

Pediatric Dentistry · Fairfax, VA

Individual Active NPI

NPI number 1801140892

Practice location

3700 Joseph Siewick Dr Ste 104
Fairfax, VA 22033-1737

Phone: (703) 620-9122

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NPI record

NPI: 1801140892
Entity type: Individual (Type 1)
Enumeration date: October 30, 2012
Last updated: January 21, 2021
Certified: January 5, 2021
Sole proprietor: No

Specialties & taxonomy codes

Taxonomy	Code	License	State
Pediatric Dentistry Primary	`1223P0221X`	2901020839	MI
General Practice Dentistry	`1223G0001X`	2901020839	MI

Mailing address

1363 Tate Modern Lane
Great Falls, VA 22066

Phone: (571) 426-8274

Other practice locations (1)

1011 N University Ave, Ann Arbor, MI 48109-1078 · (734) 764-1522

About Dr. Bastani

Nickie Rose Bastani, DDS is a healthcare provider registered in the NPI registry with the primary taxonomy Pediatric Dentistry (code 1223P0221X). The practice location is 3700 Joseph Siewick Dr Ste 104, Fairfax, VA 22033-1737. The NPI number 1801140892 was assigned on October 30, 2012 and the record was last updated on January 21, 2021.

Dr. Bastani lists 2 licenses in the registry: #2901020839 (MI) for Pediatric Dentistry; #2901020839 (MI) for General Practice Dentistry. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Nickie Rose Bastani, DDS?

The NPI number is 1801140892.

What is the phone number of Dr. Bastani?

The phone number listed for the practice location is (703) 620-9122.

Where is Dr. Bastani located?

3700 Joseph Siewick Dr Ste 104, Fairfax, VA 22033-1737.

What is the taxonomy code for Dr. Bastani?

The primary taxonomy code is 1223P0221X – Pediatric Dentistry; 1 more listed above.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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