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General NPI Number Information
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NPI Number | 1952813370
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Entity Type | Individual
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Provider Name | VALLA V GRAYELI DMD
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Gender | Male
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Dates
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Enumeration Date | 10/25/2017
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Last Update Date | 10/25/2017
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Provider Practice Location Address
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Address Line | 1001 N FAIRFAX ST STE 100
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City | ALEXANDRIA
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State | VA
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Zip | 22314-2084
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Country | US
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Telephone | 703-566-8799
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Fax |
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Provider Business Mailing Address
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Address Line | 800 WINCREST PL
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City | GREAT FALLS
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State | VA
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Zip | 22066-2736
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Country | US
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Telephone | 703-881-2600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0401415865
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License Number State | VA
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