Provider Demographics
NPI:1063070068
Name:ARMANIOUS, MINA (DDS)
Entity type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:ARMANIOUS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25619 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-6129
Mailing Address - Country:US
Mailing Address - Phone:571-533-5898
Mailing Address - Fax:
Practice Address - Street 1:25619 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-6129
Practice Address - Country:US
Practice Address - Phone:571-533-5898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401416509122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0401416509Medicaid