Provider Demographics
NPI:1700460409
Name:JUDI ORTHODONTICS PC
Entity type:Organization
Organization Name:JUDI ORTHODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
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:703-534-8711
Mailing Address - Street 1:11702U FAIR OAKS MALL
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3325
Mailing Address - Country:US
Mailing Address - Phone:703-534-8711
Mailing Address - Fax:
Practice Address - Street 1:14573 POTOMAC MILLS RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-6808
Practice Address - Country:US
Practice Address - Phone:703-534-8711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-09
Last Update Date:2021-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental