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NPI Code Detail

MEDICARE: RADWA M SOBIEH DDS

MEDICARE: RADWA M SOBIEH 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
1122300000XDentist2710OH
2122300000XDentist0401412792VA

General Provider Information

NPI Number : 1700045002
Entity Type Code : Individual
Provider Name (Legal Business Name) : RADWA M SOBIEH DDS
Provider Business Mailing Address
First Line : 2372 BIZZONE CIR
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23464-1522
Country : US
Telephone Number : 763-221-8110
Fax Number :
Provider Business Practice Location Address
First Line : 2372 BIZZONE CIR
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23464-1522
Country : US
Telephone Number : 763-221-8110
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2008
Last Update Date : 12/28/2010

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