Healthcare Provider Details

I. General information

NPI: 1548159775
Provider Name (Legal Business Name): MHD MOUAFFAK ALKHANI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7349 RICHMOND RD
WILLIAMSBURG VA
23188-7221
US

IV. Provider business mailing address

7349 RICHMOND RD
WILLIAMSBURG VA
23188-7221
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-6100
  • Fax:
Mailing address:
  • Phone: 757-384-5359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401420191
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: