Provider Demographics
NPI:1720624307
Name:DEENA HADITHI DMD, PC.
Entity Type:Organization
Organization Name:DEENA HADITHI DMD, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:HADITHI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-644-7300
Mailing Address - Street 1:7210 OLD KEENE MILL RD STE 3
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-3442
Mailing Address - Country:US
Mailing Address - Phone:703-644-7300
Mailing Address - Fax:703-866-4319
Practice Address - Street 1:7210 OLD KEENE MILL RD STE 3
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-3442
Practice Address - Country:US
Practice Address - Phone:703-644-7300
Practice Address - Fax:703-866-4319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty