# NOVA AFFORDABLE DENTAL IMPLANT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245985266
- **Authorized official:** DR. AHMED MATRI (OWNER)
- **Authorized official phone:** (646) 824-3829

## Contact information

- **Practice address:** 8209 SUDLEY RD, MANASSAS, VA 20109-3507
- **Practice address phone:** (571) 260-6222
- **Mailing address:** 8209 SUDLEY RD, MANASSAS, VA 20109-3507
- **Mailing address phone:** (646) 824-3829

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |
| 1223E0200X | Endodontics | — | NULL | — |
| 1223E0200X | Endodontics | — | — | — |
| 1223P0221X | Pediatric Dentistry | — | NULL | — |
| 1223P0221X | Pediatric Dentistry | — | — | — |
| 1223P0300X | Periodontics | — | NULL | — |
| 1223P0300X | Periodontics | — | — | — |

## Other

- **Enumeration date:** 02/17/2022
- **Last updated:** 02/17/2022