Provider Demographics
NPI:1427737295
Name:K&M DENTISTRY PLLC
Entity type:Organization
Organization Name:K&M DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HISHAM
Authorized Official - Middle Name:ESSAM A
Authorized Official - Last Name:MERDAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:857-654-0359
Mailing Address - Street 1:1854 CLARENDON BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-2914
Mailing Address - Country:US
Mailing Address - Phone:857-654-0359
Mailing Address - Fax:
Practice Address - Street 1:8316 ARLINGTON BLVD STE 305
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-5216
Practice Address - Country:US
Practice Address - Phone:857-654-0359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty