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General NPI Number Information
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NPI Number | 1053853341
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Entity Type | Organization
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Legal Business Name | TYSONS DENTAL CORNER PC
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Dates
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Enumeration Date | 11/17/2016
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Last Update Date | 11/17/2016
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Provider Practice Location Address
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Address Line | 7121 LEESBURG PIKE SUITE#204
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City | FALLS CHURCH
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State | VA
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Zip | 22043-2361
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Country | US
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Telephone | 703-237-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 7121 LEESBURG PIKE SUITE#204
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City | FALLS CHURCH
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State | VA
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Zip | 22043-2361
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Country | US
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Telephone | 703-237-5600
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | RASHA ALATHARI
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Credential |
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Telephone | 703-237-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 0401007991
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License Number State | VA
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