Healthcare Provider Details

I. General information

NPI: 1508226358
Provider Name (Legal Business Name): MILLENNIUM DENTAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6319 CASTLE PL 3F
FALLS CHURCH VA
22044-1907
US

IV. Provider business mailing address

6319 CASTLE PL 3F
FALLS CHURCH VA
22044-1907
US

V. Phone/Fax

Practice location:
  • Phone: 703-231-3506
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401414058
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. GHEED ALMUDHAFAR
Title or Position: DENTIST
Credential:
Phone: 703-231-3506