Healthcare Provider Details

I. General information

NPI: 1245963347
Provider Name (Legal Business Name): BILAL ALI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14136 MINNIEVILLE RD
WOODBRIDGE VA
22193-2313
US

IV. Provider business mailing address

14136 MINNIEVILLE RD
WOODBRIDGE VA
22193-2313
US

V. Phone/Fax

Practice location:
  • Phone: 703-583-4466
  • Fax:
Mailing address:
  • Phone: 703-583-4466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number04014182240
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: