Provider Demographics
NPI:1407433139
Name:MEKHAIL, MARK SAMEH NAGUIB (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:SAMEH NAGUIB
Last Name:MEKHAIL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11126 LIGHT GUARD LOOP
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-7635
Mailing Address - Country:US
Mailing Address - Phone:703-870-6403
Mailing Address - Fax:
Practice Address - Street 1:615 WOODBROOK DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1149
Practice Address - Country:US
Practice Address - Phone:434-293-9793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-27
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014178541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice