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General NPI Number Information
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NPI Number | 1477080570
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Entity Type | Organization
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Legal Business Name | EASY DENTAL CARE
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Dates
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Enumeration Date | 05/19/2017
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Last Update Date | 05/19/2017
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Provider Practice Location Address
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Address Line | 7522 OLD LINTON HALL RD
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City | GAINESVILLE
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State | VA
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Zip | 20155-1731
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Country | US
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Telephone | 703-753-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 7522 OLD LINTON HALL RD
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City | GAINESVILLE
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State | VA
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Zip | 20155-1731
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | AHMED EZZELDIN
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Credential |
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Telephone | 540-699-0888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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