Individual
WISSAM FAWZI ALI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
9006 CROWNWOOD CT. UNIT A, BURKE, VA 22015
(703) 672-6919
(703) 451-1863
Mailing address
7409 FLOYD AVE, SPRINGFIELD, VA 22150-3812
(703) 672-6919
(703) 451-1863
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0401410503
VA
1223D0004X
Dental Anesthesiology
Primary
0401410503
VA
Other
Enumeration date
09/25/2006
Last updated
10/22/2025
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