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General NPI Number Information
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NPI Number | 1437865342
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Entity Type | Organization
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Legal Business Name | LEESBURG DENTAL AND ORTHODONTICS, PLLC
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Dates
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Enumeration Date | 01/24/2023
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 135 ROBINSON MILL PLZ SE STE 108
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City | LEESBURG
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State | VA
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Zip | 20175-4797
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Country | US
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Telephone | 703-347-1282
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Fax |
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Provider Business Mailing Address
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Address Line | 9616 GEORGETOWN PIKE
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City | GREAT FALLS
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State | VA
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Zip | 22066-2638
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Country | US
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Telephone | 703-347-1282
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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. ZACK HICHAM MEKOUAR
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Credential | DDS
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Telephone | 703-347-1282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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