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General NPI Number Information
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NPI Number | 1457735086
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Entity Type | Organization
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Legal Business Name | ALI AND MADY DENTAL ANESTHESIOLOGY PLLC
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Dates
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Enumeration Date | 07/14/2015
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Last Update Date | 07/14/2015
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Provider Practice Location Address
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Address Line | 5284 DAWES AVE
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City | ALEXANDRIA
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State | VA
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Zip | 22311-1404
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Country | US
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Telephone | 703-379-6400
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Fax | 703-379-6407
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Provider Business Mailing Address
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Address Line | 5284 DAWES AVE
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City | ALEXANDRIA
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State | VA
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Zip | 22311-1404
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Country | US
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Telephone | 703-379-6400
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Fax | 703-379-6407
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Authorized Official
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Title or Position | OWNER
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Name | DR. WISSAM F ALI
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Credential | DMD
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Telephone | 703-379-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 0401410503
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License Number State | VA
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