Provider Demographics
NPI:1952813370
Name:GRAYELI, VALLA V (DMD)
Entity Type:Individual
Prefix:DR
First Name:VALLA
Middle Name:V
Last Name:GRAYELI
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 1:800 WINCREST PL
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-2736
Mailing Address - Country:US
Mailing Address - Phone:703-881-2600
Mailing Address - Fax:
Practice Address - Street 1:1001 N FAIRFAX ST STE 100
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2084
Practice Address - Country:US
Practice Address - Phone:703-566-8799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014158651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice