Provider Demographics
NPI:1093267239
Name:AMERICAN DENTAL CARE
Entity Type:Organization
Organization Name:AMERICAN DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:AICHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LYAZIDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-533-7285
Mailing Address - Street 1:105 N VIRGINIA AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3323
Mailing Address - Country:US
Mailing Address - Phone:703-533-7285
Mailing Address - Fax:
Practice Address - Street 1:105 N VIRGINIA AVE STE 103
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3323
Practice Address - Country:US
Practice Address - Phone:703-533-7285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410695122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1922189174Medicaid