MEDICARE: ADEL RIZKALLA 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	0401007116	VA

General Provider Information

NPI Number	:	1639255029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADEL RIZKALLA D.D.S.

Provider Business Mailing Address
First Line	:	3100 S MANCHESTER ST
Second Line	:	SUITE T-4
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2711
Country	:	US
Telephone Number	:	703-671-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 S MANCHESTER ST
Second Line	:	SUITE T-4
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2711
Country	:	US
Telephone Number	:	703-671-2222
Fax Number	:

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	07/09/2007

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