Provider Demographics
NPI:1679599484
Name:TADROS, AMEAR MAHROUS (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMEAR
Middle Name:MAHROUS
Last Name:TADROS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5305 TRACTOR LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7240
Mailing Address - Country:US
Mailing Address - Phone:703-430-2020
Mailing Address - Fax:
Practice Address - Street 1:46090 LAKE CENTER PLZ
Practice Address - Street 2:SUITE 202
Practice Address - City:POTOMAC FALLS
Practice Address - State:VA
Practice Address - Zip Code:20165-5876
Practice Address - Country:US
Practice Address - Phone:703-430-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014109641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice