Provider Demographics
NPI:1578090395
Name:AL-SABBAGH, ANAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANAS
Middle Name:
Last Name:AL-SABBAGH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 MERRITT RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1423
Mailing Address - Country:US
Mailing Address - Phone:919-599-0786
Mailing Address - Fax:
Practice Address - Street 1:4607 DUKE ST UNIT 19A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2505
Practice Address - Country:US
Practice Address - Phone:571-899-5094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2022-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN20000451223P0300X
MD174091223P0300X
VA04014176861223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics