Provider Demographics
NPI:1275722027
Name:KHATEEB, MARIAM ABDELRAZIG (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:ABDELRAZIG
Last Name:KHATEEB
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 1:5200 LYNGATE CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1631
Mailing Address - Country:US
Mailing Address - Phone:703-978-1903
Mailing Address - Fax:
Practice Address - Street 1:238 POTOMAC AVE
Practice Address - Street 2:
Practice Address - City:QUANTICO
Practice Address - State:VA
Practice Address - Zip Code:22134-3459
Practice Address - Country:US
Practice Address - Phone:703-640-1000
Practice Address - Fax:703-630-2526
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014007531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry