Provider Demographics
NPI:1447093026
Name:MY ASHBURN DENTIST PLLC
Entity type:Organization
Organization Name:MY ASHBURN DENTIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAYTH
Authorized Official - Middle Name:GHANIM
Authorized Official - Last Name:ALDABBAGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-799-2609
Mailing Address - Street 1:20925 PROFESSIONAL PLZ STE 330
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3403
Mailing Address - Country:US
Mailing Address - Phone:440-799-2609
Mailing Address - Fax:
Practice Address - Street 1:20925 PROFESSIONAL PLZ STE 330
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3403
Practice Address - Country:US
Practice Address - Phone:703-726-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-13
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty