# DR MIB DDS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902487150
- **Authorized official:** DR. MOHAMED IBRAHIM DDS (OWNER)
- **Authorized official phone:** (703) 624-8188

## Contact information

- **Practice address:** 12973 HIGHLAND CROSSING DR STE B, HERNDON, VA 20171-5890
- **Practice address phone:** (703) 953-3307
- **Mailing address:** 401 12TH ST S APT 1712, ARLINGTON, VA 22202-4237
- **Mailing address phone:** (703) 624-8188

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 04/19/2021
- **Last updated:** 04/19/2021