Provider Demographics
NPI:1366873127
Name:HABIBA DENTAL PC
Entity type:Organization
Organization Name:HABIBA DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EZZAT
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDOUN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-295-3598
Mailing Address - Street 1:1516 N SHENANDOAH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-3648
Mailing Address - Country:US
Mailing Address - Phone:540-636-2003
Mailing Address - Fax:540-636-2004
Practice Address - Street 1:1516 N SHENANDOAH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-3648
Practice Address - Country:US
Practice Address - Phone:540-636-2003
Practice Address - Fax:540-636-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412811122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty