| Elghannam Dental Llc | |
|
4421 Dale Blvd Ste 202 Woodbridge VA 22193-2550 | |
| (615) 499-0438 | |
| Not Available |
| Full Name | Elghannam Dental Llc |
|---|---|
| Speciality | Dentist |
| Location | 4421 Dale Blvd Ste 202, Woodbridge, Virginia |
| Authorized Official Name and Position | Mohamed M Elghannam (CEO) |
| Authorized Official Contact | 6154990438 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elghannam Dental Llc 4421 Dale Blvd Ste 202 Woodbridge VA 22193-2550 Ph: () - | Elghannam Dental Llc 4421 Dale Blvd Ste 202 Woodbridge VA 22193-2550 Ph: (615) 499-0438 |
| NPI Number | 1164234910 |
|---|---|
| Provider Enumeration Date | 01/20/2025 |
| Last Update Date | 01/22/2025 |
| Medicare PECOS PAC ID | 9739604786 |
|---|---|
| Medicare Enrollment ID | O20250422003248 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164234910 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| Provider Name | Mohamed M Elghannam |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1831717180 PECOS PAC ID: 1254720576 Enrollment ID: I20250422003327 |
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