Medhat R. Abu-Ghannam, DDS
Individual provider Active NPI General Practice Dentistry · Burke, VA
NPI 1720109200 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1720109200
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 0401410846 (VA)
- Practice address
- 9239 Old Keene Mill Rd
Burke, VA 22015-4202 - Phone
- (703) 455-7770
- Fax
- (703) 997-2530
- NPI assigned
- Apr 3, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|
| 0401410846 | VA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 0401410846 | VA | Yes |
Addresses
Primary practice location
9239 Old Keene Mill Rd
Burke, VA 22015-4202
Mailing address
2520 Terra Cotta Cir
Herndon, VA 20171
Phone (703) 956-6015
Other names
- Medhat R. Ghannam
Other providers in Burke, VA
- A Plus TLC Home Health Inc
- A-1 Companion & Elder Care Inc.
- Omer Abdullah
- Fouzia Abisourour
- Majeed N/a Abu Nimer
- Amy Hinz Adair
- Bolaji Folasade Adedeji
- Jessica Emily Aguilar
- Farzal J Ahmed
- Ilhan Mohamed Ahmed
All providers in Burke, VA · General Practice Dentistry in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.