Provider Demographics
NPI:1023217593
Name:ATTIA, MOHAMED H (DDS, FAGD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:H
Last Name:ATTIA
Suffix:
Gender:M
Credentials:DDS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 GROVEDALE DR
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310
Mailing Address - Country:US
Mailing Address - Phone:703-719-9305
Mailing Address - Fax:703-719-9139
Practice Address - Street 1:6420 GROVEDALE DR
Practice Address - Street 2:SUITE 100A
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-2500
Practice Address - Country:US
Practice Address - Phone:703-719-9305
Practice Address - Fax:703-719-9139
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412033122300000X
NC1506201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist