Provider Demographics
NPI:1538533021
Name:MOUNT VERNON DENTAL CARE
Entity type:Organization
Organization Name:MOUNT VERNON DENTAL CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZEYAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MADY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-360-5881
Mailing Address - Street 1:8101 HINSON FARM RD STE 114
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3404
Mailing Address - Country:US
Mailing Address - Phone:703-360-5880
Mailing Address - Fax:703-360-6083
Practice Address - Street 1:8101 HINSON FARM RD STE 114
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3404
Practice Address - Country:US
Practice Address - Phone:703-360-5881
Practice Address - Fax:703-360-6083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1679969554OtherNPI
1962560920OtherNPI
VA1831245075OtherNPI