Provider Demographics
NPI:1144738626
Name:ADVANCED DENTAL CARE OF STAFFORD
Entity Type:Organization
Organization Name:ADVANCED DENTAL CARE OF STAFFORD
Other - Org Name:ADVANCED DENTAL CARE OF STAFFORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ARAFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-891-9911
Mailing Address - Street 1:10524 SPOTSYLVANIA AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-8611
Mailing Address - Country:US
Mailing Address - Phone:540-891-9911
Mailing Address - Fax:
Practice Address - Street 1:2052 JEFFERSON DAVIS HWY STE 103
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7286
Practice Address - Country:US
Practice Address - Phone:540-288-2800
Practice Address - Fax:540-659-3536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014130631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty