Mohamad Bashar Ayass, DMD

Individual provider Active NPI General Practice Dentistry · Centreville, VA

NPI 1730465154 · NPPES record last updated Oct 31, 2011

Key facts

NPI
1730465154
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
0401411737 (VA)
Practice address
14631 Lee Hwy
#301
Centreville, VA 20121
Phone
(703) 830-2256
NPI assigned
Oct 31, 2011
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

LicenseStateTypeSpecialty
0401411737VAMDGeneral Practice Dentistry

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 0401411737 VA Yes

Addresses

Primary practice location

14631 Lee Hwy
#301
Centreville, VA 20121

Mailing address

14631 Lee Hwy
#301
Centreville, VA 20121-5824
Phone (703) 830-2256

Other providers in Centreville, VA

All providers in Centreville, VA · General Practice Dentistry in Virginia

Sources for this page

Verify at the official NPI Registry.