MEDICARE: NADA HEMEDAN DMD

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	1223G0001X	General Practice Dentistry	0401410778	VA
2	122300000X	Dentist	0401410778	VA

General Provider Information

NPI Number	:	1942333984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADA HEMEDAN DMD

Provider Business Mailing Address
First Line	:	9671 A MAIN STREET
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031
Country	:	US
Telephone Number	:	703-978-0000
Fax Number	:	703-978-0005

Provider Business Practice Location Address
First Line	:	9671 A MAIN STREET
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031
Country	:	US
Telephone Number	:	703-978-0000
Fax Number	:	703-978-0005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	05/20/2014

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