Provider Demographics
NPI:1942654199
Name:IRIS DENTAL CARE
Entity Type:Organization
Organization Name:IRIS DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAWSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOUSY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-865-8457
Mailing Address - Street 1:305 MAPLE AVE W
Mailing Address - Street 2:SUITE E.
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:305 MAPLE AVE W
Practice Address - Street 2:SUITE E.
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4306
Practice Address - Country:US
Practice Address - Phone:703-865-8455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008611122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty