Provider Demographics
NPI:1356451132
Name:AYOUBI, IMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:IMAN
Middle Name:
Last Name:AYOUBI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:IMAN
Other - Middle Name:
Other - Last Name:AL-AYOUBI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:500 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-5308
Mailing Address - Country:US
Mailing Address - Phone:703-955-7232
Mailing Address - Fax:
Practice Address - Street 1:171 ELDEN ST
Practice Address - Street 2:SUITE 2C3
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4875
Practice Address - Country:US
Practice Address - Phone:703-956-6168
Practice Address - Fax:703-964-9899
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411724122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist