NPIMap

Organization Active NPI

Dr Mib DDS PLLC

  • Dentist
  • Herndon, VA
National Provider Identifier
1902487150
Registry record updated Apr 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
DR MIB DDS PLLC
Practice address
12973 Highland Crossing Dr Ste B
Herndon, VA 20171-5890
Phone
(703) 953-3307
NPI assigned
Apr 19, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mohamed Ibrahim, DDSNPI 1659888717
Title
Owner
Phone
(703) 624-8188

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

12973 Highland Crossing Dr Ste B
Herndon, VA 20171-5890

Mailing address

401 12TH St S Apt 1712
Arlington, VA 22202-4237
Phone (703) 624-8188

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1618790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618790400000",
    "number": "1902487150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 12TH ST S APT 1712",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222024237",
            "telephone_number": "703-624-8188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12973 HIGHLAND CROSSING DR STE B",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201715890",
            "telephone_number": "703-953-3307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR MIB DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-19",
        "last_updated": "2021-04-19",
        "certification_date": "2021-04-19",
        "status": "A",
        "authorized_official_last_name": "IBRAHIM",
        "authorized_official_first_name": "MOHAMED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-624-8188",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Herndon, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.