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General NPI Number Information
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NPI Number | 1861559171
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Entity Type | Organization
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Legal Business Name | MAZIN ALAYSSAMI, DMD & ASSOCIATES PC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 13873 PARK CENTER RD
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City | HERNDON
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State | VA
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Zip | 20171-3223
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Country | US
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Telephone | 703-478-0115
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Fax |
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Provider Business Mailing Address
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Address Line | 13873 PARK CENTER RD
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City | HERNDON
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State | VA
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Zip | 20171-3223
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Country | US
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Telephone | 703-478-0115
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAZIN ALAYSSAMI
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Credential |
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Telephone | 703-478-0115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8416
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License Number State | VA
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