Provider Demographics
NPI:1386982122
Name:ABDOLAHI, MINA EILEEN (DDS)
Entity type:Individual
Prefix:DR
First Name:MINA
Middle Name:EILEEN
Last Name:ABDOLAHI
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 1:20622 GLENMERE SQ
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-3563
Mailing Address - Country:US
Mailing Address - Phone:703-927-0711
Mailing Address - Fax:
Practice Address - Street 1:21155 WHITFIELD PL
Practice Address - Street 2:SUITE 107
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-7281
Practice Address - Country:US
Practice Address - Phone:703-404-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2015-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413394122300000X
IA30343390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program