Provider Demographics
NPI:1194164814
Name:ALMUDHAFAR, GHEED J (DDS)
Entity type:Individual
Prefix:DR
First Name:GHEED
Middle Name:J
Last Name:ALMUDHAFAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6319 CASTLE PL
Mailing Address - Street 2:3F
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-1907
Mailing Address - Country:US
Mailing Address - Phone:571-489-8111
Mailing Address - Fax:571-489-8110
Practice Address - Street 1:6319 CASTLE PL
Practice Address - Street 2:3F
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-1907
Practice Address - Country:US
Practice Address - Phone:571-489-8111
Practice Address - Fax:571-489-8110
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-15
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014140581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice