MEDICARE: ELHADY DENTAL 2 PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	0401415272	VA
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	0401410821	VA
3	122300000X	Dentist	0401410263	VA

General Provider Information

NPI Number	:	1043790942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELHADY DENTAL 2 PLLC

Provider Business Mailing Address
First Line	:	7462 LIMESTONE DR
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-4007
Country	:	US
Telephone Number	:	703-753-3346
Fax Number	:

Provider Business Practice Location Address
First Line	:	7462 LIMESTONE DR
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-4007
Country	:	US
Telephone Number	:	703-753-3346
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHERIF ELHADY
Credential	:	DDS
Telephone Number	:	703-753-3346

Provider Enumeration Date	:	08/20/2018
Last Update Date	:	08/20/2018

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