Provider Demographics
NPI:1396187548
Name:ALAYSSAMI DENTAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:ALAYSSAMI DENTAL ASSOCIATES, PC
Other - Org Name:CONNECTICUT FAMILY DENTAL, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAZIN
Authorized Official - Middle Name:SHIBLI
Authorized Official - Last Name:ALAYSSAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-850-2028
Mailing Address - Street 1:4444 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE # 106
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2318
Mailing Address - Country:US
Mailing Address - Phone:202-363-2810
Mailing Address - Fax:202-966-3601
Practice Address - Street 1:4444 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE # 106
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2318
Practice Address - Country:US
Practice Address - Phone:202-363-2810
Practice Address - Fax:202-966-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty