Healthcare Provider Details

I. General information

NPI: 1689177073
Provider Name (Legal Business Name): SHAMOONA SHARIF DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 ONTARIO RD NW
WASHINGTON DC
20009-2627
US

IV. Provider business mailing address

6717 SWINDON PL
MANASSAS VA
20112-5569
US

V. Phone/Fax

Practice location:
  • Phone: 202-483-8196
  • Fax:
Mailing address:
  • Phone: 571-225-6081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401416310
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: