Healthcare Provider Details

I. General information

NPI: 1255789541
Provider Name (Legal Business Name): METRO DENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 F ST NW SUITE 203
WASHINGTON DC
20037-2715
US

IV. Provider business mailing address

8370 GREENSBORO DR APT 901
MC LEAN VA
22102-3515
US

V. Phone/Fax

Practice location:
  • Phone: 202-363-5720
  • Fax: 703-934-4705
Mailing address:
  • Phone: 703-934-4474
  • Fax: 703-934-4705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JAKLIN BEZIK
Title or Position: OWNER
Credential: DDS, MDS
Phone: 703-934-4474