Provider Demographics
NPI:1679284970
Name:MINA ARMANIOUS, DDS, PLLC
Entity Type:Organization
Organization Name:MINA ARMANIOUS, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMANIOUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-239-7575
Mailing Address - Street 1:21035 SYCOLIN RD STE 85
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4311
Mailing Address - Country:US
Mailing Address - Phone:703-239-7575
Mailing Address - Fax:571-517-2106
Practice Address - Street 1:21035 SYCOLIN RD STE 85
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-4311
Practice Address - Country:US
Practice Address - Phone:703-239-7575
Practice Address - Fax:571-517-2106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1063070068Medicaid
VA30017501710001Medicaid