Healthcare Provider Details

I. General information

NPI: 1740698257
Provider Name (Legal Business Name): NOUREDDIN TAFFAL DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 HAYNES POINT WAY UNIT D
ALEXANDRIA VA
22315-6017
US

IV. Provider business mailing address

7710 HAYNES POINT WAY UNIT D
ALEXANDRIA VA
22315-6017
US

V. Phone/Fax

Practice location:
  • Phone: 716-706-9900
  • Fax:
Mailing address:
  • Phone: 716-706-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN1001396
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number2020008265
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: