Provider Demographics
NPI:1598146318
Name:AVATAR DENTAL CARE
Entity Type:Organization
Organization Name:AVATAR DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TALIB
Authorized Official - Middle Name:SALIM
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-669-8600
Mailing Address - Street 1:545 E MARKET ST STE G
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4172
Mailing Address - Country:US
Mailing Address - Phone:703-669-8600
Mailing Address - Fax:
Practice Address - Street 1:545 E MARKET ST STE G
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4172
Practice Address - Country:US
Practice Address - Phone:703-669-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412553261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental