Provider Demographics
NPI:1700029279
Name:BACHOUR, MAYA BASSAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAYA
Middle Name:BASSAM
Last Name:BACHOUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20405 EXCHANGE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5934
Mailing Address - Country:US
Mailing Address - Phone:703-297-4407
Mailing Address - Fax:
Practice Address - Street 1:20405 EXCHANGE ST STE 201
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5934
Practice Address - Country:US
Practice Address - Phone:703-297-4407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411337122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist