Provider Demographics
NPI:1033508148
Name:AESTHETIC DENTISTRY OF OAKTON LLC
Entity Type:Organization
Organization Name:AESTHETIC DENTISTRY OF OAKTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-255-1150
Mailing Address - Street 1:2936 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-3003
Mailing Address - Country:US
Mailing Address - Phone:703-255-1150
Mailing Address - Fax:703-255-2733
Practice Address - Street 1:2936 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-3003
Practice Address - Country:US
Practice Address - Phone:703-255-1150
Practice Address - Fax:703-255-2733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014136521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty