Provider Demographics
NPI:1811083942
Name:ABOU NAHLAH, ESAM (DDS)
Entity type:Individual
Prefix:
First Name:ESAM
Middle Name:
Last Name:ABOU NAHLAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 NORTH GLEBE RD.
Mailing Address - Street 2:SUITE 1260
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203
Mailing Address - Country:US
Mailing Address - Phone:703-294-6144
Mailing Address - Fax:703-294-6147
Practice Address - Street 1:671 NORTH GLEBE RD.
Practice Address - Street 2:SUITE 1260
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203
Practice Address - Country:US
Practice Address - Phone:703-294-6144
Practice Address - Fax:703-294-6147
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50716122300000X
VA0401414141331223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist