Healthcare Provider Details

I. General information

NPI: 1427737295
Provider Name (Legal Business Name): K&M DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 ARLINGTON BLVD STE 305
FAIRFAX VA
22031-5216
US

IV. Provider business mailing address

1854 CLARENDON BLVD
ARLINGTON VA
22201-2914
US

V. Phone/Fax

Practice location:
  • Phone: 857-654-0359
  • Fax:
Mailing address:
  • Phone: 857-654-0359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. HISHAM ESSAM A MERDAD
Title or Position: MEMBER
Credential: DDS
Phone: 857-654-0359