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General NPI Number Information
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NPI Number | 1356451132
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Entity Type | Individual
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Provider Name | IMAN AYOUBI D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 10/14/2013
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Provider Practice Location Address
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Address Line | 171 ELDEN ST SUITE 2C3
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City | HERNDON
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State | VA
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Zip | 20170-4875
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Country | US
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Telephone | 703-956-6168
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Fax | 703-964-9899
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Provider Business Mailing Address
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Address Line | 500 ASPEN DR
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City | HERNDON
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State | VA
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Zip | 20170-5308
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Country | US
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Telephone | 703-955-7232
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401411724
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License Number State | VA
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