Healthcare Provider Details

I. General information

NPI: 1316383979
Provider Name (Legal Business Name): MOHAMED HAKIM D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N GLEBE RD STE 203
ARLINGTON VA
22207-3558
US

IV. Provider business mailing address

2501 N GLEBE RD STE 203
ARLINGTON VA
22207-3558
US

V. Phone/Fax

Practice location:
  • Phone: 703-504-2141
  • Fax:
Mailing address:
  • Phone: 703-504-2141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2901600490
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDEN2000357
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401415895
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number17970
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: