Provider Demographics
NPI:1750765061
Name:JUREIDINI, ALAN ELIE
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:ELIE
Last Name:JUREIDINI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N STUART ST
Mailing Address - Street 2:APT 1618
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-4101
Mailing Address - Country:US
Mailing Address - Phone:347-206-1552
Mailing Address - Fax:
Practice Address - Street 1:900 N STUART ST
Practice Address - Street 2:APT 1618
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-4101
Practice Address - Country:US
Practice Address - Phone:347-206-1552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014147171223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics