Healthcare Provider Details

I. General information

NPI: 1043790942
Provider Name (Legal Business Name): ELHADY DENTAL 2 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7462 LIMESTONE DR
GAINESVILLE VA
20155-4007
US

IV. Provider business mailing address

7462 LIMESTONE DR
GAINESVILLE VA
20155-4007
US

V. Phone/Fax

Practice location:
  • Phone: 703-753-3346
  • Fax:
Mailing address:
  • Phone: 703-753-3346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401415272
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401410821
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401410263
License Number StateVA

VIII. Authorized Official

Name: SHERIF ELHADY
Title or Position: OWNER
Credential: DDS
Phone: 703-753-3346