Provider Demographics
NPI:1386094175
Name:MUKBEL, ASEEL (DDS)
Entity type:Individual
Prefix:
First Name:ASEEL
Middle Name:
Last Name:MUKBEL
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 1:22860 QUANTE SQ
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-7313
Mailing Address - Country:US
Mailing Address - Phone:424-273-7192
Mailing Address - Fax:
Practice Address - Street 1:7696 RICHMOND HWY STE D
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-2843
Practice Address - Country:US
Practice Address - Phone:424-273-7192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014160001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice