Provider Demographics
NPI:1740698257
Name:TAFFAL, NOUREDDIN (DDS, MD)
Entity type:Individual
Prefix:
First Name:NOUREDDIN
Middle Name:
Last Name:TAFFAL
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7710 HAYNES POINT WAY UNIT D
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-6017
Mailing Address - Country:US
Mailing Address - Phone:716-706-9900
Mailing Address - Fax:
Practice Address - Street 1:7710 HAYNES POINT WAY UNIT D
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-6017
Practice Address - Country:US
Practice Address - Phone:716-706-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1001396122300000X
MO2020008265204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist