Provider Demographics
NPI:1346424140
Name:ABOULKHAIR, MOSTAFA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MOSTAFA
Middle Name:
Last Name:ABOULKHAIR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4103 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE LL100
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4107
Mailing Address - Country:US
Mailing Address - Phone:703-218-8142
Mailing Address - Fax:703-218-8143
Practice Address - Street 1:4103 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE LL100
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4107
Practice Address - Country:US
Practice Address - Phone:703-218-8142
Practice Address - Fax:703-218-8143
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411899122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes122300000XDental ProvidersDentist