MEDICARE: AMERICAN DENTAL CARE

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	122300000X	Dentist	0401410695	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093267239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN DENTAL CARE

Provider Business Mailing Address
First Line	:	105 N VIRGINIA AVE STE 103
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-3323
Country	:	US
Telephone Number	:	703-533-7285
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 N VIRGINIA AVE STE 103
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-3323
Country	:	US
Telephone Number	:	703-533-7285
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	AICHA LYAZIDI
Credential	:
Telephone Number	:	703-533-7285

Provider Enumeration Date	:	11/03/2016
Last Update Date	:	11/03/2016

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Directions to “AMERICAN DENTAL CARE ” Practice Location

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