Healthcare Provider Details

I. General information

NPI: 1043124126
Provider Name (Legal Business Name): IVYMONT DENTAL (AMINE DENTAL, PLLC)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MAHMOUD MOHAMAD AMINE
Title or Position: PRACTICE OWNER/DENTIST
Credential: DDS
Phone: 423-747-2779