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General NPI Number Information
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NPI Number | 1710853676
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Entity Type | Organization
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Legal Business Name | GRACE TMJ & URGENT DENTAL CARE INC
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Dates
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Enumeration Date | 10/16/2025
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 611 S CARLIN SPRINGS RD STE 502
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City | ARLINGTON
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State | VA
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Zip | 22204-1088
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Country | US
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Telephone | 703-469-7435
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Fax |
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Provider Business Mailing Address
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Address Line | 611 S CARLIN SPRINGS RD STE 502
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City | ARLINGTON
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State | VA
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Zip | 22204-1088
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Country | US
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Telephone | 703-469-7435
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HANI HANNA
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Credential | DDS
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Telephone | 703-479-9010
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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 |
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License Number State |
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