Provider Demographics
NPI:1386892313
Name:AQUIA DENTAL CARE
Entity type:Organization
Organization Name:AQUIA DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AICHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LYAZIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-720-8630
Mailing Address - Street 1:2712 JEFFERSON DAVIS HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1733
Mailing Address - Country:US
Mailing Address - Phone:540-720-8630
Mailing Address - Fax:540-720-8632
Practice Address - Street 1:2712 JEFFERSON DAVIS HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1733
Practice Address - Country:US
Practice Address - Phone:540-720-8630
Practice Address - Fax:540-720-8632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410695261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental