Becker Rafid Bahar Al Mayouf, D.M.D
Individual provider Active NPI Dentist · Fairfax, VA
NPI 1508533647 · NPPES record last updated Aug 26, 2025
Key facts
- NPI
- 1508533647
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 10000735 (MA)
- Practice address
- 9450 Fairfax Blvd Apt 1630
Fairfax, VA 22031-2432 - Phone
- (484) 655-8952
- NPI assigned
- Aug 26, 2021
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10000735 | MA | MD | Dentist |
| 0401417474 | VA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0401417474 | VA | |
| Dentist | 122300000X | 17557 | MD | |
| Dentist | 122300000X | 10000735 | MA | Yes |
Addresses
Primary practice location
9450 Fairfax Blvd Apt 1630
Fairfax, VA 22031-2432
Mailing address
345 Harrison Ave Apt 462
Boston, MA 02118-3064
Phone (484) 655-8952
Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 26, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.