Healthcare Provider Details

I. General information

NPI: 1881348951
Provider Name (Legal Business Name): AL-KARAGHOLI DENTISTRY OF MERRIFIELD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8190 STRAWBERRY LN STE 10
FALLS CHURCH VA
22042-1030
US

IV. Provider business mailing address

8190 STRAWBERRY LN STE 10
FALLS CHURCH VA
22042-1030
US

V. Phone/Fax

Practice location:
  • Phone: 703-204-0050
  • Fax:
Mailing address:
  • Phone: 703-204-0050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: MUSTAFA AL-KARAGHOLI
Title or Position: OWNER
Credential:
Phone: 703-204-0050