Provider Demographics
NPI:1992553093
Name:ELITE PEDIATRICS DENTISTRY & ORTHODONTICS PPLC
Entity type:Organization
Organization Name:ELITE PEDIATRICS DENTISTRY & ORTHODONTICS PPLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:AMMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-MAHDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-251-4045
Mailing Address - Street 1:6565 ARLINGTON BLVD STE 501
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-3018
Mailing Address - Country:US
Mailing Address - Phone:703-534-8711
Mailing Address - Fax:
Practice Address - Street 1:11836 HALL STREET
Practice Address - Street 2:
Practice Address - City:BEALETON
Practice Address - State:VA
Practice Address - Zip Code:22712
Practice Address - Country:US
Practice Address - Phone:540-251-4045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty