NPI Code Detail JSON Logo

1720109200 NPI number — MEDHAT R. ABU-GHANNAM DDS

NPI Number: 1720109200
Health Care Provider/Practitioner: MEDHAT R. ABU-GHANNAM DDS

Information about “1720109200” NPI (MEDHAT R. ABU-GHANNAM DDS) exists in 1720109200 in HTML format HTML  |  1720109200 in plain Text format TXT  |  1720109200 in PDF (Portable Document Format) PDF  |  1720109200 in an XML format XML  formats.

NPI Number : 1720109200 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720109200",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ABU-GHANNAM",
    "FirstName": "MEDHAT",
    "MiddleName": "R.",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DDS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "GHANNAM",
    "OtherFirstName": "MEDHAT",
    "OtherMiddleName": "R.",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "DDS",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "2520 TERRA COTTA CIR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HERNDON",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "20171",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "703-956-6015",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "9239 OLD KEENE MILL RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BURKE",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22015-4202",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "703-455-7770",
    "PracticeLocationAddressFaxNumber": "703-997-2530",
    "EnumerationDate": "04/03/2007",
    "LastUpdateDate": "07/08/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1223G0001X",
        "TaxonomyName": "General Practice Dentistry",
        "LicenseNumber": "0401410846",
        "LicenseNumberStateCode": "VA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.