Healthcare Provider Details

I. General information

NPI: 1528781671
Provider Name (Legal Business Name): ELMASRY DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 PRINCE WILLIAM PKWY
WOODBRIDGE VA
22192-4145
US

IV. Provider business mailing address

4434 DAVIS FAIRFAX LN
WOODBRIDGE VA
22192-5580
US

V. Phone/Fax

Practice location:
  • Phone: 703-583-7720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. ABU-BAKR EL-MASRY
Title or Position: DENTIST
Credential: DDS
Phone: 972-750-0440