Provider Demographics
NPI:1730465154
Name:AYASS, MOHAMAD BASHAR (DMD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:BASHAR
Last Name:AYASS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14631 LEE HWY
Mailing Address - Street 2:#301
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-5824
Mailing Address - Country:US
Mailing Address - Phone:703-830-2256
Mailing Address - Fax:
Practice Address - Street 1:14631 LEE HWY
Practice Address - Street 2:#301
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121
Practice Address - Country:US
Practice Address - Phone:703-830-2256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014117371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice