Provider Demographics
NPI:1518138163
Name:LURAY DENTAL CLINIC
Entity Type:Organization
Organization Name:LURAY DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:M
Authorized Official - Last Name:ASHMAWY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-743-4810
Mailing Address - Street 1:156 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LURAY
Mailing Address - State:VA
Mailing Address - Zip Code:22835-1366
Mailing Address - Country:US
Mailing Address - Phone:540-743-4810
Mailing Address - Fax:540-743-7936
Practice Address - Street 1:156 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LURAY
Practice Address - State:VA
Practice Address - Zip Code:22835-1366
Practice Address - Country:US
Practice Address - Phone:540-743-4810
Practice Address - Fax:540-743-7936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9199709Medicaid