Individual provider Active NPI

Wissam Fawzi Ali, DMD

  • Dental Anesthesiology
  • Burke, VA
National Provider Identifier
1396845558
Registry record updated Oct 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental AnesthesiologyTaxonomy code 1223D0004X
License
0401410503 Issued in VA
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, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

LicenseStateTypeSpecialty
0401410503VAMDDentist 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.

Verify at the official NPI Registry.