Individual
DR. MEDHAT R. ABU-GHANNAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
9239 OLD KEENE MILL RD, BURKE, VA 22015-4202
(703) 455-7770
(703) 997-2530
Mailing address
2520 TERRA COTTA CIR, HERNDON, VA 20171
(703) 956-6015
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401410846
VA
Other
Enumeration date
04/03/2007
Last updated
07/08/2007
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