Healthcare Provider Details

I. General information

NPI: 1306299185
Provider Name (Legal Business Name): YOUSUF AL-ABOOSI DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7617 LITTLE RIVER TPKE STE 910
ANNANDALE VA
22003-2618
US

IV. Provider business mailing address

7617 LITTLE RIVER TPKE STE 910
ANNANDALE VA
22003-2618
US

V. Phone/Fax

Practice location:
  • Phone: 703-462-9092
  • Fax: 703-256-7722
Mailing address:
  • Phone: 703-462-9092
  • Fax: 703-256-7722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number0401417005
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: