Provider Demographics
NPI:1366822827
Name:M & M DENTAL CARE P.C.
Entity Type:Organization
Organization Name:M & M DENTAL CARE P.C.
Other - Org Name:AESTHETIC DENTISTRY OF FAIRFAX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOSTAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOULKHAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-218-8142
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-31
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014118991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty