MEDICARE: IRIS DENTAL CARE

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	122300000X	Dentist	0401008611	VA

General Provider Information

NPI Number	:	1942654199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRIS DENTAL CARE

Provider Business Mailing Address
First Line	:	305 MAPLE AVE W
Second Line	:	SUITE E.
City	:	VIENNA
State	:	VA
Zip	:	22180-4306
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 MAPLE AVE W
Second Line	:	SUITE E.
City	:	VIENNA
State	:	VA
Zip	:	22180-4306
Country	:	US
Telephone Number	:	703-865-8455
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SAWSAN ABOUSY
Credential	:
Telephone Number	:	703-865-8457

Provider Enumeration Date	:	04/13/2016
Last Update Date	:	04/13/2016

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Directions to “IRIS DENTAL CARE ” Practice Location

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