MEDICARE: DR. SHAMS UL ISLAM DMD

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	122300000X	Dentist	16959	MD

General Provider Information

NPI Number	:	1598326407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAMS UL ISLAM DMD

Provider Business Mailing Address
First Line	:	21307 DENIT ESTATES DR
Second Line	:
City	:	BROOKEVILLE
State	:	MD
Zip	:	20833-1837
Country	:	US
Telephone Number	:	301-661-5138
Fax Number	:

Provider Business Practice Location Address
First Line	:	2802 RHODE ISLAND AVE NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20018-2998
Country	:	US
Telephone Number	:	202-269-3387
Fax Number	:

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

Provider Enumeration Date	:	06/23/2019
Last Update Date	:	06/23/2019

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