Healthcare Provider Details

I. General information

NPI: 1164230322
Provider Name (Legal Business Name): HEBAH H ABU SHAKRA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 WISCONSIN AVE NW STE 240
WASHINGTON DC
20016-4126
US

IV. Provider business mailing address

11229 POTOMAC CREST DR
ROCKVILLE MD
20854-2769
US

V. Phone/Fax

Practice location:
  • Phone: 202-686-2318
  • Fax:
Mailing address:
  • Phone: 202-818-0078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18154
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2000431
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: