Provider Demographics
NPI:1841697356
Name:ELGEDDAWI, ALY (DDS)
Entity type:Individual
Prefix:DR
First Name:ALY
Middle Name:
Last Name:ELGEDDAWI
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 1:8303 ARLINGTON BLVD.
Mailing Address - Street 2:SUITE #104
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031
Mailing Address - Country:US
Mailing Address - Phone:703-207-0700
Mailing Address - Fax:571-419-6923
Practice Address - Street 1:8303 ARLINGTON BLVD.
Practice Address - Street 2:SUITE #104
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031
Practice Address - Country:US
Practice Address - Phone:703-207-0700
Practice Address - Fax:571-419-6923
Is Sole Proprietor?:No
Enumeration Date:2014-11-26
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414896122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist