Organization
TRISTATE ORAL SURGERY PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AYESHA NAWAB MD DMD (OWNER)
(713) 822-4648
Entity
Organization
Contact information
Practice address
5659 COLUMBIA PIKE, SUITE 100, FALLS CHURCH, VA 22041-2878
(703) 417-9840
Mailing address
6408 STONEHAM RD, BETHESDA, MD 20817-1628
(713) 822-4648
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
0401413171
VA
Other
Enumeration date
07/09/2014
Last updated
07/09/2014
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