Provider Demographics
NPI:1710198775
Name:ELGHOBASHI, AHMED M (DDS)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:M
Last Name:ELGHOBASHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 BRANDON AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150
Mailing Address - Country:US
Mailing Address - Phone:703-451-1656
Mailing Address - Fax:703-451-3347
Practice Address - Street 1:6120 BRANDON AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150
Practice Address - Country:US
Practice Address - Phone:703-451-1656
Practice Address - Fax:703-451-3347
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014116761223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice