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General NPI Number Information
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NPI Number | 1699392308
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Entity Type | Individual
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Provider Name | DR. MAHMOOD ALHAJYAT
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Gender | Male
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Dates
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Enumeration Date | 06/29/2020
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Last Update Date | 07/20/2023
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Provider Practice Location Address
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Address Line | 121 LOUISA AVE
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City | MINERAL
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State | VA
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Zip | 23117
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Country | US
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Telephone | 540-894-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 121 LOUISA AVE
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City | MINERAL
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State | VA
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Zip | 23117-4518
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Country | US
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Telephone | 929-232-5519
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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 | 0401416926
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License Number State | VA
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