MEDICARE: MARK SAMEH NAGUIB MEKHAIL DDS

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	0401417854	VA
2	1223G0001X	General Practice Dentistry	30.028237	OH

General Provider Information

NPI Number	:	1407433139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK SAMEH NAGUIB MEKHAIL DDS

Provider Business Mailing Address
First Line	:	11126 LIGHT GUARD LOOP
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20109-7635
Country	:	US
Telephone Number	:	703-870-6403
Fax Number	:

Provider Business Practice Location Address
First Line	:	36050 DETROIT RD STE T
Second Line	:
City	:	AVON
State	:	OH
Zip	:	44011-1685
Country	:	US
Telephone Number	:	440-870-6486
Fax Number	:

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

Provider Enumeration Date	:	03/27/2021
Last Update Date	:	12/16/2025

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