Provider Demographics
NPI:1639255029
Name:RIZKALLA, ADEL (DDS)
Entity Type:Individual
Prefix:
First Name:ADEL
Middle Name:
Last Name:RIZKALLA
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 1:3100 S MANCHESTER ST
Mailing Address - Street 2:SUITE T-4
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2711
Mailing Address - Country:US
Mailing Address - Phone:703-671-2222
Mailing Address - Fax:
Practice Address - Street 1:3100 S MANCHESTER ST
Practice Address - Street 2:SUITE T-4
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2711
Practice Address - Country:US
Practice Address - Phone:703-671-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010071161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice