Provider Demographics
NPI:1619298239
Name:AHMAD, IMANEY N (DMD)
Entity Type:Individual
Prefix:DR
First Name:IMANEY
Middle Name:N
Last Name:AHMAD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2465 CENTREVILLE RD
Mailing Address - Street 2:SUITE J-15
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-4586
Mailing Address - Country:US
Mailing Address - Phone:703-793-0291
Mailing Address - Fax:703-793-0292
Practice Address - Street 1:2465 CENTREVILLE RD
Practice Address - Street 2:SUITE J-15
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4586
Practice Address - Country:US
Practice Address - Phone:703-793-0291
Practice Address - Fax:703-793-0292
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014129481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice