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General NPI Number Information
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NPI Number | 1144738626
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Entity Type | Organization
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Legal Business Name | ADVANCED DENTAL CARE OF STAFFORD
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 01/18/2018
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Provider Practice Location Address
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Address Line | 2052 JEFFERSON DAVIS HWY STE 103
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City | STAFFORD
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State | VA
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Zip | 22554-7286
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Country | US
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Telephone | 540-288-2800
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Fax | 540-659-3536
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Provider Business Mailing Address
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Address Line | 10524 SPOTSYLVANIA AVE STE 104
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City | FREDERICKSBURG
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State | VA
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Zip | 22408-8611
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Country | US
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Telephone | 540-891-9911
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | MOHAMED ARAFA
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Credential |
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Telephone | 540-891-9911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401413063
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License Number State | VA
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