MEDICARE: HICHAM MEKOUAR DDS PC

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	411070	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	:	1215143326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HICHAM MEKOUAR DDS PC

Provider Business Mailing Address
First Line	:	7462 LIMESTONE DR
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-4007
Country	:	US
Telephone Number	:	703-753-3346
Fax Number	:	703-753-8836

Provider Business Practice Location Address
First Line	:	7462 LIMESTONE DR
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-4007
Country	:	US
Telephone Number	:	703-753-3346
Fax Number	:	703-753-8836

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HICHAM MEKOUAR
Credential	:	DDS
Telephone Number	:	703-753-3346

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	04/28/2010

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