Healthcare Provider Details

I. General information

NPI: 1396187548
Provider Name (Legal Business Name): ALAYSSAMI DENTAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 CONNECTICUT AVE NW SUITE # 106
WASHINGTON DC
20008-2318
US

IV. Provider business mailing address

4444 CONNECTICUT AVE NW SUITE # 106
WASHINGTON DC
20008-2318
US

V. Phone/Fax

Practice location:
  • Phone: 202-363-2810
  • Fax: 202-966-3601
Mailing address:
  • Phone: 202-363-2810
  • Fax: 202-966-3601

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: DR. MAZIN SHIBLI ALAYSSAMI
Title or Position: OWNER
Credential: DMD
Phone: 703-850-2028