1437865342 NPI number — LEESBURG DENTAL AND ORTHODONTICS, PLLC

Table of content: (NPI 1437865342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437865342 NPI number — LEESBURG DENTAL AND ORTHODONTICS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEESBURG DENTAL AND ORTHODONTICS, 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:
Provider Other Organization Name Type Code:
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:
1437865342
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9616 GEORGETOWN PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREAT FALLS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22066-2638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-347-1282
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 ROBINSON MILL PLZ SE STE 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20175-4797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-347-1282
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/24/2023

Additional Information

Authorized Official

Authorized Official Last Name:
MEKOUAR
Authorized Official First Name:
ZACK
Authorized Official Middle Name:
HICHAM
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
703-347-1282

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223X0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com