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General NPI Number Information
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NPI Number | 1508226358
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Entity Type | Organization
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Legal Business Name | MILLENNIUM DENTAL CARE PLLC
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Dates
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Enumeration Date | 03/07/2016
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Last Update Date | 03/07/2016
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Provider Practice Location Address
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Address Line | 6319 CASTLE PL 3F
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City | FALLS CHURCH
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State | VA
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Zip | 22044-1907
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Country | US
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Telephone | 703-231-3506
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Fax |
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Provider Business Mailing Address
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Address Line | 6319 CASTLE PL 3F
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City | FALLS CHURCH
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State | VA
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Zip | 22044-1907
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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 | DENTIST
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Name | DR. GHEED ALMUDHAFAR
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Credential |
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Telephone | 703-231-3506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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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 | 0401414058
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License Number State | VA
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