1700385184 NPI number — SNOOZE DENTAL CARE PLLC

Table of content: (NPI 1700385184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700385184 NPI number — SNOOZE DENTAL CARE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SNOOZE DENTAL CARE PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CENTER FOR DENTAL ANESTHESIA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700385184
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5284 DAWES AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22311-1404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-379-6400
Provider Business Mailing Address Fax Number:
703-376-6407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5284 DAWES AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22311-1404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-379-6400
Provider Business Practice Location Address Fax Number:
703-376-6407
Provider Enumeration Date:
02/12/2018

Additional Information

Authorized Official

Authorized Official Last Name:
MADY
Authorized Official First Name:
ZEYAD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
703-379-6400

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  VA0401411611 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: VA0401006164 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: VA0401415781 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1831245075 . This is a "DENTIST" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1922467190 . This is a "DENTIST" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1962560920 . This is a "DENTIST" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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