Provider Demographics
NPI:1396125001
Name:EYAD ALBARQ DDS., PC
Entity type:Organization
Organization Name:EYAD ALBARQ DDS., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EYAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBARQ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-953-5272
Mailing Address - Street 1:8603 WESTWOOD CENTER DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182
Mailing Address - Country:US
Mailing Address - Phone:571-282-3939
Mailing Address - Fax:571-395-8461
Practice Address - Street 1:8603 WESTWOOD CENTER DR
Practice Address - Street 2:SUITE 310
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182
Practice Address - Country:US
Practice Address - Phone:571-282-3939
Practice Address - Fax:571-395-8461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014120351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2719188Medicaid