=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043124126
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IVYMONT DENTAL (AMINE DENTAL, PLLC)
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2026
-----------------------------------------------------
Last Update Date | 09/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14269 MIDLOTHIAN TPKE
-----------------------------------------------------
City | MIDLOTHIAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23113-6560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-747-2779
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14269 MIDLOTHIAN TPKE
-----------------------------------------------------
City | MIDLOTHIAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23113-6560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE OWNER/DENTIST
-----------------------------------------------------
Name | DR. MAHMOUD MOHAMAD AMINE
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 423-747-2779
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------