Provider Demographics
NPI:1053145508
Name:MAHGOUB DDS PLLC
Entity type:Organization
Organization Name:MAHGOUB DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDULLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHGOUB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-467-3397
Mailing Address - Street 1:24305 LIBERTY HARVEST CT STE 110
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-3422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24305 LIBERTY HARVEST CT STE 110
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-3422
Practice Address - Country:US
Practice Address - Phone:703-775-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty