Provider Demographics
NPI:1922630052
Name:AL JARRAH, LINA MUSTAFA
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:MUSTAFA
Last Name:AL JARRAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45716 IMPERIAL SQ APT 216
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-7015
Mailing Address - Country:US
Mailing Address - Phone:347-654-1950
Mailing Address - Fax:
Practice Address - Street 1:8140 STONEWALL SHOPS SQ
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3891
Practice Address - Country:US
Practice Address - Phone:571-298-8279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014168051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice