Healthcare Provider Details

I. General information

NPI: 1609181593
Provider Name (Legal Business Name): ABDULRAHMAN AL-EHMELI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 N 11TH ST WOOD MEMORIAL BUILDING 3-311
RICHMOND VA
23298-5045
US

IV. Provider business mailing address

PO BOX 980566 ORAL AND MAXILLOFACIAL SURGERY
RICHMOND VA
23298-0566
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-3584
  • Fax:
Mailing address:
  • Phone: 804-628-6637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0442000122
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: