Provider Demographics
NPI:1518841519
Name:NOVA DENTAL ANESTHESIA OF WINCHESTER PLLC
Entity type:Organization
Organization Name:NOVA DENTAL ANESTHESIA OF WINCHESTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST ANESTHESIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:WISSAM
Authorized Official - Middle Name:FAWZI
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:571-221-5737
Mailing Address - Street 1:3363 SHAWNEE DR STE 2B
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-6301
Mailing Address - Country:US
Mailing Address - Phone:540-507-3529
Mailing Address - Fax:
Practice Address - Street 1:3363 SHAWNEE DR STE 2B
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-6301
Practice Address - Country:US
Practice Address - Phone:540-507-3529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDental AnesthesiologyGroup - Single Specialty