Provider Demographics
NPI:1609102052
Name:VAHAB, PHILIP J (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:J
Last Name:VAHAB
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:131 ELDEN ST
Mailing Address - Street 2:SUITE 130A
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4876
Mailing Address - Country:US
Mailing Address - Phone:703-689-3901
Mailing Address - Fax:703-689-3903
Practice Address - Street 1:131 ELDEN ST
Practice Address - Street 2:SUITE 130A
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4876
Practice Address - Country:US
Practice Address - Phone:703-689-3901
Practice Address - Fax:703-689-3903
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2012-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MD144531223X0400X
VA04014124611223X0400X
DCDEN 10009421223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics