Provider Demographics
NPI:1134341068
Name:ARMANIOUS, MARK M (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:M
Last Name:ARMANIOUS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24600 MILLSTREAM DR
Mailing Address - Street 2:SUITE 490
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-5685
Mailing Address - Country:US
Mailing Address - Phone:703-327-5655
Mailing Address - Fax:703-327-7655
Practice Address - Street 1:24600 MILLSTREAM DR
Practice Address - Street 2:SUITE 490
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-5685
Practice Address - Country:US
Practice Address - Phone:703-327-5655
Practice Address - Fax:703-327-7655
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY527741223G0001X
VA04014135461223S0112X
NY0527741223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice