=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104123900
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DUKE DENTAL CARE, PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2011
-----------------------------------------------------
Last Update Date | 02/15/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 S PICKETT ST SUITE 229
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22304-7207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-212-0000
-----------------------------------------------------
Fax | 703-212-0001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 S PICKETT ST SUITE 229
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22304-7207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-212-0000
-----------------------------------------------------
Fax | 703-212-0001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TREASURER
-----------------------------------------------------
Name | DR. MAHER SANGID
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 703-212-0000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------