MEDICARE: DR. ABRAHAM SHAIT D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	05226	VA

General Provider Information

NPI Number	:	1588731186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABRAHAM SHAIT D.D.S.

Provider Business Mailing Address
First Line	:	3210 SKIPWITH RD
Second Line	:	SUITE D
City	:	RICHMOND
State	:	VA
Zip	:	23294-4443
Country	:	US
Telephone Number	:	804-270-7070
Fax Number	:	804-270-0277

Provider Business Practice Location Address
First Line	:	3210 SKIPWITH RD
Second Line	:	SUITE D
City	:	RICHMOND
State	:	VA
Zip	:	23294-4443
Country	:	US
Telephone Number	:	804-270-7070
Fax Number	:	804-270-0277

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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