Provider Demographics
NPI:1124645577
Name:ELSADIG, NADA (DDS)
Entity type:Individual
Prefix:DR
First Name:NADA
Middle Name:
Last Name:ELSADIG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5007 QUELL CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-8906
Mailing Address - Country:US
Mailing Address - Phone:571-228-6592
Mailing Address - Fax:
Practice Address - Street 1:5007 QUELL CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-8906
Practice Address - Country:US
Practice Address - Phone:571-228-6592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014169551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice