Provider Demographics
NPI:1699392308
Name:ALHAJYAT, MAHMOOD
Entity Type:Individual
Prefix:DR
First Name:MAHMOOD
Middle Name:
Last Name:ALHAJYAT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 LOUISA AVE
Mailing Address - Street 2:
Mailing Address - City:MINERAL
Mailing Address - State:VA
Mailing Address - Zip Code:23117-4518
Mailing Address - Country:US
Mailing Address - Phone:929-232-5519
Mailing Address - Fax:
Practice Address - Street 1:121 LOUISA AVE
Practice Address - Street 2:
Practice Address - City:MINERAL
Practice Address - State:VA
Practice Address - Zip Code:23117
Practice Address - Country:US
Practice Address - Phone:540-894-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401416926122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist