Provider Demographics
NPI:1508263104
Name:HAWASLI, AHMAD
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:
Last Name:HAWASLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5811 CHASE COMMONS CT
Mailing Address - Street 2:APT# 208
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-4611
Mailing Address - Country:US
Mailing Address - Phone:773-629-0329
Mailing Address - Fax:
Practice Address - Street 1:8100 ASHTON AVE
Practice Address - Street 2:STE 212
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5622
Practice Address - Country:US
Practice Address - Phone:773-629-0329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014149731223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics