Healthcare Provider Details

I. General information

NPI: 1184533002
Provider Name (Legal Business Name): ALI AL-FAKHRI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19420 GOLF VISTA PLZ STE 210
LANSDOWNE VA
20176-8267
US

IV. Provider business mailing address

19420 GOLF VISTA PLZ STE 210
LANSDOWNE VA
20176-8267
US

V. Phone/Fax

Practice location:
  • Phone: 703-734-0515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401420189
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN2001709
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: