Provider Demographics
NPI:1871645929
Name:ALHUSSAIN, IBRAHIM Y (DMD)
Entity Type:Individual
Prefix:DR
First Name:IBRAHIM
Middle Name:Y
Last Name:ALHUSSAIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1500 CORNERSIDE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2433
Mailing Address - Country:US
Mailing Address - Phone:703-821-2222
Mailing Address - Fax:703-821-2221
Practice Address - Street 1:1500 CORNERSIDE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2433
Practice Address - Country:US
Practice Address - Phone:703-821-2222
Practice Address - Fax:703-821-2221
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014115591223X0400X, 1223X0400X
MD135031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics