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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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