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General NPI Number Information
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NPI Number | 1740590405
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE ORAL & FACIAL SURGERY LLC
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Dates
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Enumeration Date | 10/15/2010
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Last Update Date | 10/15/2010
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Provider Practice Location Address
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Address Line | 6845 ELM ST SUITE 305
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City | MC LEAN
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State | VA
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Zip | 22101-6007
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Country | US
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Telephone | 240-274-7257
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Fax |
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Provider Business Mailing Address
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Address Line | 6845 ELM ST SUITE 305
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City | MC LEAN
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State | VA
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Zip | 22101-6007
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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 | DR. ZIAD A ALI
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Credential | DMD, MD
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Telephone | 240-274-7257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0401412450
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License Number State | VA
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