Provider Demographics
NPI:1841000239
Name:SPRINGFIELD ENDODONTICS
Entity type:Organization
Organization Name:SPRINGFIELD ENDODONTICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-JANABI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD, MSC
Authorized Official - Phone:571-303-0313
Mailing Address - Street 1:43145 VALIANT DR
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-3423
Mailing Address - Country:US
Mailing Address - Phone:317-989-9730
Mailing Address - Fax:
Practice Address - Street 1:7426 ALBAN STATION BLVD STE B202
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2323
Practice Address - Country:US
Practice Address - Phone:317-989-9730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-09
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty