MEDICARE: SOFIYA WALI

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	0401102580	VA

General Provider Information

NPI Number	:	1275640138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOFIYA WALI

Provider Business Mailing Address
First Line	:	3604 FOREST DR
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-1005
Country	:	US
Telephone Number	:	703-379-9292
Fax Number	:	703-379-5559

Provider Business Practice Location Address
First Line	:	3604 FOREST DR
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-1005
Country	:	US
Telephone Number	:	703-379-9292
Fax Number	:	703-379-5559

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	07/08/2007

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Directions to “ SOFIYA WALI ” Practice Location

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