Organization
MERDAD DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HISHAM ESSAM A MERDAD BDS, DSCD (OWNER CEO)
(857) 654-0359
Entity
Organization
Contact information
Practice address
7522 OLD LINTON HALL RD, GAINESVILLE, VA 20155-1731
(857) 654-0359
Mailing address
750 PORT ST APT 1626, ALEXANDRIA, VA 22314-6472
(857) 654-0359
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
0401414352
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144656356
—
MI
Enumeration date
03/15/2018
Last updated
03/15/2018
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