MEDICARE: RADWA M SOBIEH DDS PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1689146334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADWA M SOBIEH DDS PLLC

Provider Business Mailing Address
First Line	:	650 CEDAR CREEK GRADE STE 205
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-6454
Country	:	US
Telephone Number	:	540-323-7063
Fax Number	:	540-860-7007

Provider Business Practice Location Address
First Line	:	650 CEDAR CREEK GRADE STE 205
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-6454
Country	:	US
Telephone Number	:	540-323-7063
Fax Number	:	540-860-7007

Authorized Official
Title or Position	:	DENTIST
Name	:	RADWA SOBIEH
Credential	:	DDS MS
Telephone Number	:	763-269-9944

Provider Enumeration Date	:	12/19/2018
Last Update Date	:	12/19/2018

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