Provider Demographics
NPI:1710552260
Name:GREATER WASHINGTON ORAL AND MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:GREATER WASHINGTON ORAL AND MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HARON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-225-2259
Mailing Address - Street 1:10009 SOUTHPOINT PKWY STE 201-A
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-2709
Mailing Address - Country:US
Mailing Address - Phone:540-225-2259
Mailing Address - Fax:540-225-2253
Practice Address - Street 1:10009 SOUTHPOINT PKWY STE 201-A
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-2709
Practice Address - Country:US
Practice Address - Phone:540-225-2259
Practice Address - Fax:540-225-2253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty