Healthcare Provider Details

I. General information

NPI: 1194286898
Provider Name (Legal Business Name): WALEED RABAH ALKAKHAN DDS, MSD, MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 BEVERLY RD STE 210
MC LEAN VA
22101-3654
US

IV. Provider business mailing address

1355 BEVERLY RD STE 210
MC LEAN VA
22101-3654
US

V. Phone/Fax

Practice location:
  • Phone: 703-288-3570
  • Fax:
Mailing address:
  • Phone: 703-288-3570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number0401416769
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: