Provider Demographics
NPI:1760624613
Name:TRABOULSI, GEORGES (DDS)
Entity Type:Individual
Prefix:
First Name:GEORGES
Middle Name:
Last Name:TRABOULSI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:GEORGES
Other - Middle Name:
Other - Last Name:TRABOULSI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5419 BACKLICK RD.
Mailing Address - Street 2:C
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151
Mailing Address - Country:US
Mailing Address - Phone:703-256-8554
Mailing Address - Fax:703-256-1029
Practice Address - Street 1:5419 BACKLICK RD.
Practice Address - Street 2:C
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151
Practice Address - Country:US
Practice Address - Phone:703-256-8554
Practice Address - Fax:703-256-1029
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014133441223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics