MEDICARE: DR. JAILAN ABDELRAZEK D .D.S

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	0401410144	VA

General Provider Information

NPI Number	:	1174681738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAILAN ABDELRAZEK D .D.S

Provider Business Mailing Address
First Line	:	46165 WESTLAKE DR STE 110
Second Line	:
City	:	POTOMAC FALLS
State	:	VA
Zip	:	20165-5872
Country	:	US
Telephone Number	:	703-444-6150
Fax Number	:	703-444-6151

Provider Business Practice Location Address
First Line	:	46165 WESTLAKE DR STE 110
Second Line	:
City	:	POTOMAC FALLS
State	:	VA
Zip	:	20165-5872
Country	:	US
Telephone Number	:	703-444-6150
Fax Number	:	703-444-6151

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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