Healthcare Provider Details

I. General information

NPI: 1447703046
Provider Name (Legal Business Name): MAHMOUD MOHAMAD AMINE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2016
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14269 MIDLOTHIAN TPKE
MIDLOTHIAN VA
23113-6560
US

IV. Provider business mailing address

14269 MIDLOTHIAN TPKE
MIDLOTHIAN VA
23113-6560
US

V. Phone/Fax

Practice location:
  • Phone: 423-747-2779
  • Fax:
Mailing address:
  • Phone: 423-747-2779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401416171
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: