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General NPI Number Information
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NPI Number | 1407026156
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Entity Type | Organization
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Legal Business Name | ELITE DENTAL CARE, P.C.
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 03/10/2008
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Provider Practice Location Address
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Address Line | 23520 OVERLAND DR SUITE 134
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City | DULLES
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State | VA
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Zip | 20166-2196
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Country | US
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Telephone | 703-661-6380
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Fax |
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Provider Business Mailing Address
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Address Line | 23520 OVERLAND DR SUITE 134
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City | DULLES
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State | VA
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Zip | 20166-2196
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Country | US
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Telephone | 703-661-6380
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KHALID MANSOUR HUSSEIN
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Credential | DDS
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Telephone | 703-661-6380
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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 | 0401411564
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License Number State | VA
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