Individual
IYA GHASSIB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS,MS
Contact information
Practice address
520 N 12TH ST, RICHMOND, VA 23298-5064
(734) 604-7960
Mailing address
520 N 12TH ST, RICHMOND, VA 23298-5064
(734) 604-7960
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
0401418640
VA
Other
Enumeration date
01/02/2023
Last updated
05/13/2024
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