Provider Demographics
NPI:1134706658
Name:ALY ELGEDDAWI, DDS, PLLC
Entity type:Organization
Organization Name:ALY ELGEDDAWI, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELGEDDAWI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:571-236-1318
Mailing Address - Street 1:8342 TRAFORD LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1638
Mailing Address - Country:US
Mailing Address - Phone:703-644-5955
Mailing Address - Fax:703-644-1337
Practice Address - Street 1:8342 TRAFORD LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1638
Practice Address - Country:US
Practice Address - Phone:703-644-5955
Practice Address - Fax:703-644-1337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental