Healthcare Provider Details

I. General information

NPI: 1336991496
Provider Name (Legal Business Name): DANA HAISSAM EL-JANNOUN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 TRAFORD LN STE A
SPRINGFIELD VA
22152-1671
US

IV. Provider business mailing address

4444 CHASE PARK CT
ANNANDALE VA
22003-5729
US

V. Phone/Fax

Practice location:
  • Phone: 703-451-1656
  • Fax:
Mailing address:
  • Phone: 703-678-8456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401419595
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: