Provider Demographics
NPI:1992918494
Name:MUSMAR, QAIS (DDS)
Entity type:Individual
Prefix:DR
First Name:QAIS
Middle Name:
Last Name:MUSMAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6395 LITTLE RIVER TPKE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-5003
Mailing Address - Country:US
Mailing Address - Phone:703-256-3313
Mailing Address - Fax:703-642-2397
Practice Address - Street 1:6395 LITTLE RIVER TPKE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-5003
Practice Address - Country:US
Practice Address - Phone:703-256-3313
Practice Address - Fax:703-642-2397
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401102769122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist