Provider Demographics
NPI:1083112395
Name:ALI M MUALLA DDS PLLC
Entity Type:Organization
Organization Name:ALI M MUALLA DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:M
Authorized Official - Last Name:MUALLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-669-8600
Mailing Address - Street 1:545 E MARKET ST STE G
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4172
Mailing Address - Country:US
Mailing Address - Phone:703-669-8600
Mailing Address - Fax:
Practice Address - Street 1:545 E MARKET ST STE G
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4172
Practice Address - Country:US
Practice Address - Phone:703-669-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415214261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental