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NPI Code Detail

MEDICARE: PROVIDENCE DENTAL ARTS

MEDICARE: PROVIDENCE DENTAL ARTS
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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1235060864
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROVIDENCE DENTAL ARTS
Provider Business Mailing Address
First Line : 3028 JAVIER RD STE 101
Second Line :
City : FAIRFAX
State : VA
Zip : 22031-4622
Country : US
Telephone Number : 301-222-7896
Fax Number : 301-222-7896
Provider Business Practice Location Address
First Line : 3028 JAVIER RD STE 101
Second Line :
City : FAIRFAX
State : VA
Zip : 22031-4622
Country : US
Telephone Number : 301-222-7896
Fax Number : 301-222-7896
Authorized Official
Title or Position : DENTIST
Name : ISSA I ABOU AYYASH
Credential :
Telephone Number : 301-222-7896
Provider Enumeration Date : 05/25/2026
Last Update Date : 05/25/2026

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Directions to “PROVIDENCE DENTAL ARTS ” Practice Location

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