MEDICARE: DR. KHALID MANSOUR HUSSEIN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1000489	DC
2	1223G0001X	General Practice Dentistry	0401411564	VA
3	1223G0001X	General Practice Dentistry	0513531	NY
4	1223G0001X	General Practice Dentistry	13576	MD

General Provider Information

NPI Number	:	1073736377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHALID MANSOUR HUSSEIN DDS

Provider Business Mailing Address
First Line	:	3900 FAIRFAX DRIVE
Second Line	:	APT 224
City	:	ARLINGTON
State	:	VA
Zip	:	22203-1662
Country	:	US
Telephone Number	:	571-201-7416
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 FAIRFAX DRIVE
Second Line	:	APT 224
City	:	ARLINGTON
State	:	VA
Zip	:	22203-1662
Country	:	US
Telephone Number	:	571-201-7416
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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