Provider Demographics
NPI:1326454562
Name:N R EMAD DDS PC
Entity Type:Organization
Organization Name:N R EMAD DDS PC
Other - Org Name:NOVA DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FRONT DESK
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-938-7615
Mailing Address - Street 1:307 F MAPLE AVE. W #100
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180
Mailing Address - Country:US
Mailing Address - Phone:703-938-7615
Mailing Address - Fax:703-242-9417
Practice Address - Street 1:307 F MAPLE AVE. W #100
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180
Practice Address - Country:US
Practice Address - Phone:703-938-7615
Practice Address - Fax:703-242-9417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4010071851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty