Provider Demographics
NPI:1174681738
Name:ABDELRAZEK, JAILAN (D DS)
Entity Type:Individual
Prefix:DR
First Name:JAILAN
Middle Name:
Last Name:ABDELRAZEK
Suffix:
Gender:F
Credentials:D DS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46165 WESTLAKE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:POTOMAC FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5872
Mailing Address - Country:US
Mailing Address - Phone:703-444-6150
Mailing Address - Fax:703-444-6151
Practice Address - Street 1:46165 WESTLAKE DR STE 110
Practice Address - Street 2:
Practice Address - City:POTOMAC FALLS
Practice Address - State:VA
Practice Address - Zip Code:20165-5872
Practice Address - Country:US
Practice Address - Phone:703-444-6150
Practice Address - Fax:703-444-6151
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014101441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice