Organization
LEGACY DENTAL IMPLANT
Active
Other names
Legacy dental implant, legacy dental implant
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AHMED MATRI (OWNER)
(646) 824-3829
Entity
Organization
Contact information
Practice address
3000 10TH ST N, ARLINGTON, VA 22201-2162
(646) 824-3829
Mailing address
3000 10TH ST N, ARLINGTON, VA 22201-2162
(646) 824-3829
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223E0200X
Endodontics
—
—
1223P0300X
Periodontics
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
06/27/2024
Last updated
06/27/2024
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