Healthcare Provider Details

I. General information

NPI: 1407433139
Provider Name (Legal Business Name): MARK SAMEH NAGUIB MEKHAIL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2021
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 WOODBROOK DR
CHARLOTTESVILLE VA
22901-1149
US

IV. Provider business mailing address

11126 LIGHT GUARD LOOP
MANASSAS VA
20109-7635
US

V. Phone/Fax

Practice location:
  • Phone: 434-293-9793
  • Fax:
Mailing address:
  • Phone: 703-870-6403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401417854
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: