Provider Demographics
NPI:1437036621
Name:ELIAS, DIANA WAHID FARAG (DDS)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:WAHID FARAG
Last Name:ELIAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:FARAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8716 CALVERT CLIFF CT
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-3027
Mailing Address - Country:US
Mailing Address - Phone:657-259-7398
Mailing Address - Fax:657-259-7398
Practice Address - Street 1:6354 WALKER LN STE 103
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3242
Practice Address - Country:US
Practice Address - Phone:657-259-7398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401419709122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist