Provider Demographics
NPI:1508533647
Name:AL MAYOUF, BECKER RAFID BAHAR (DMD)
Entity Type:Individual
Prefix:
First Name:BECKER
Middle Name:RAFID BAHAR
Last Name:AL MAYOUF
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 1:9450 FAIRFAX BLVD APT 1630
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2432
Mailing Address - Country:US
Mailing Address - Phone:484-655-8952
Mailing Address - Fax:
Practice Address - Street 1:9450 FAIRFAX BLVD APT 1630
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2432
Practice Address - Country:US
Practice Address - Phone:484-655-8952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401417474122300000X
MD17557122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist