Provider Demographics
NPI:1174960827
Name:EDELBI, DINA (DMD)
Entity type:Individual
Prefix:DR
First Name:DINA
Middle Name:
Last Name:EDELBI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11353 ANDREW LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5507
Mailing Address - Country:US
Mailing Address - Phone:703-867-8691
Mailing Address - Fax:
Practice Address - Street 1:8310 OLD COURTHOUSE RD STE A
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3872
Practice Address - Country:US
Practice Address - Phone:703-356-0250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414014122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist