Healthcare Provider Details

I. General information

NPI: 1740610245
Provider Name (Legal Business Name): AHMAD REDA HATAHET DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ELDEN ST STE 12
HERNDON VA
20170-4833
US

IV. Provider business mailing address

12190 ABINGTON HALL PL APT 203
RESTON VA
20190-5818
US

V. Phone/Fax

Practice location:
  • Phone: 703-303-7777
  • Fax:
Mailing address:
  • Phone: 703-303-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901021192
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401418624
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: