Provider Demographics
NPI:1881151504
Name:ABOUEL ENIN, MAHA M
Entity type:Individual
Prefix:
First Name:MAHA
Middle Name:M
Last Name:ABOUEL ENIN
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 1:14228 SMOKETOWN RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4708
Mailing Address - Country:US
Mailing Address - Phone:703-794-2006
Mailing Address - Fax:
Practice Address - Street 1:14228 SMOKETOWN RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4708
Practice Address - Country:US
Practice Address - Phone:703-793-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401416371122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist