Provider Demographics
NPI:1154588903
Name:AL-KARAGHOLI DENTISTRY OF HERNDON, PC
Entity type:Organization
Organization Name:AL-KARAGHOLI DENTISTRY OF HERNDON, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARA
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:AZIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-787-2273
Mailing Address - Street 1:1094 ELDEN ST
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-3803
Mailing Address - Country:US
Mailing Address - Phone:703-787-2273
Mailing Address - Fax:703-787-8243
Practice Address - Street 1:1094 ELDEN ST
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-3803
Practice Address - Country:US
Practice Address - Phone:703-787-2273
Practice Address - Fax:703-787-8243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410175122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty