Provider Demographics
NPI:1518568070
Name:MOSTAFA ABOULKHAIR, DMD, P.C.
Entity Type:Organization
Organization Name:MOSTAFA ABOULKHAIR, DMD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOSTAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOULKHAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:434-791-2192
Mailing Address - Street 1:3284 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-3429
Mailing Address - Country:US
Mailing Address - Phone:434-791-2192
Mailing Address - Fax:
Practice Address - Street 1:3284 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-3429
Practice Address - Country:US
Practice Address - Phone:434-791-2192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty