Healthcare Provider Details

I. General information

NPI: 1841000239
Provider Name (Legal Business Name): SPRINGFIELD ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7426 ALBAN STATION BLVD STE B202
SPRINGFIELD VA
22150-2323
US

IV. Provider business mailing address

43145 VALIANT DR
CHANTILLY VA
20152-3423
US

V. Phone/Fax

Practice location:
  • Phone: 317-989-9730
  • Fax:
Mailing address:
  • Phone: 317-989-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: ANMAR AL-JANABI
Title or Position: OWNER
Credential: DDS, MSD, MSC
Phone: 571-303-0313