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General NPI Number Information
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NPI Number | 1366876856
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Entity Type | Organization
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Legal Business Name | TYSONS DENTAL CARE PLLC
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Dates
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Enumeration Date | 09/03/2013
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Last Update Date | 09/03/2013
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Provider Practice Location Address
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Address Line | 7787 LEESBURG PIKE #2
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City | FALLS CHURCH
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State | VA
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Zip | 22043
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Country | US
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Telephone | 703-506-4700
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Fax | 703-734-1172
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Provider Business Mailing Address
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Address Line | 7787 LEESBURG PIKE #2
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City | FALLS CHURCH
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State | VA
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Zip | 22043
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Country | US
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Telephone | 703-506-4700
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Fax | 703-734-1172
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Authorized Official
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Title or Position | OWNER
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Name | DR. ADEL S KEBAISH
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Credential | M.D.
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Telephone | 703-506-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401412828
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License Number State | VA
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