Provider Demographics
NPI:1265847669
Name:AL-JANABI, ANMAR (BDS, MSD, MEC)
Entity Type:Individual
Prefix:
First Name:ANMAR
Middle Name:
Last Name:AL-JANABI
Suffix:
Gender:M
Credentials:BDS, MSD, MEC
Other - Prefix:
Other - First Name:ANMAR
Other - Middle Name:
Other - Last Name:JANABI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BDS, MSD, MSC
Mailing Address - Street 1:25815 MEWS TER
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-6360
Mailing Address - Country:US
Mailing Address - Phone:317-989-9730
Mailing Address - Fax:
Practice Address - Street 1:13880 BRADDOCK RD
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2459
Practice Address - Country:US
Practice Address - Phone:703-815-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.029565122300000X
IL0210031181223E0200X
VA04014176741223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist