Active NPI
Wissam Fawzi Ali, DMD
- Dental Anesthesiology
- Burke, VA
National Provider Identifier
1396845558
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Anesthesiology
- License
- 0401410503
- Practice address
- 9006 Crownwood CT. Unit a
Burke, VA 22015 - Phone
- (703) 672-6919
- Fax
- (703) 451-1863
- NPI assigned
- Sep 25, 2006
- Last updated
- Oct 22, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0401410503 | VA | |
| Dental Anesthesiology | 1223D0004X | 0401410503 | VA | Primary |
Addresses
Primary practice location
9006 Crownwood CT. Unit a
Burke, VA 22015
Mailing address
7409 Floyd Ave
Springfield, VA 22150-3812
Phone (703) 672-6919
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401410503 | VA | MD | Dentist Anesthesiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761091200000",
"number": "1396845558",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7409 FLOYD AVE",
"city": "SPRINGFIELD",
"state": "VA",
"postal_code": "221503812",
"telephone_number": "703-672-6919",
"fax_number": "703-451-1863"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9006 CROWNWOOD CT. UNIT A",
"city": "BURKE",
"state": "VA",
"postal_code": "22015",
"telephone_number": "703-672-6919",
"fax_number": "703-451-1863"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALI",
"first_name": "WISSAM",
"middle_name": "FAWZI",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-25",
"last_updated": "2025-10-22",
"certification_date": "2025-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401410503",
"primary": false
},
{
"code": "1223D0004X",
"taxonomy_group": "",
"desc": "Dentist, Dental Anesthesiology",
"state": "VA",
"license": "0401410503",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Burke, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.