Provider Demographics
NPI:1902243116
Name:ELBADAWY, TAREK (DDS)
Entity Type:Individual
Prefix:
First Name:TAREK
Middle Name:
Last Name:ELBADAWY
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 1:6255 COLLEGE DR.
Mailing Address - Street 2:SUITE #E
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-0018
Mailing Address - Country:US
Mailing Address - Phone:917-912-2793
Mailing Address - Fax:
Practice Address - Street 1:46175 WESTLAKE DR STE 130
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-5873
Practice Address - Country:US
Practice Address - Phone:917-912-2793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414260122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist