Healthcare Provider Details

I. General information

NPI: 1336889757
Provider Name (Legal Business Name): ANTHONY SHAHATA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8221 RITCHIE HWY STE 201
PASADENA MD
21122-3941
US

IV. Provider business mailing address

8221 RITCHIE HWY STE 201
PASADENA MD
21122-3941
US

V. Phone/Fax

Practice location:
  • Phone: 410-647-3453
  • Fax:
Mailing address:
  • Phone: 410-647-3453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number18553
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: