Provider Demographics
NPI:1053853341
Name:TYSONS DENTAL CORNER PC
Entity Type:Organization
Organization Name:TYSONS DENTAL CORNER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALATHARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-237-5600
Mailing Address - Street 1:7121 LEESBURG PIKE
Mailing Address - Street 2:SUITE#204
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-2361
Mailing Address - Country:US
Mailing Address - Phone:703-237-5600
Mailing Address - Fax:
Practice Address - Street 1:7121 LEESBURG PIKE
Practice Address - Street 2:SUITE#204
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-2361
Practice Address - Country:US
Practice Address - Phone:703-237-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007991261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental