Provider Demographics
NPI:1215143326
Name:HICHAM MEKOUAR DDS PC
Entity type:Organization
Organization Name:HICHAM MEKOUAR DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HICHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MEKOUAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-753-3346
Mailing Address - Street 1:7462 LIMESTONE DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-4007
Mailing Address - Country:US
Mailing Address - Phone:703-753-3346
Mailing Address - Fax:703-753-8836
Practice Address - Street 1:7462 LIMESTONE DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-4007
Practice Address - Country:US
Practice Address - Phone:703-753-3346
Practice Address - Fax:703-753-8836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA411070122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010335621Medicaid