Healthcare Provider Details

I. General information

NPI: 1346383486
Provider Name (Legal Business Name): AMRO H. SHIHABI DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 03/22/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5206 LYNGATE CT
BURKE VA
22015
US

IV. Provider business mailing address

5206 LYNGATE CT
BURKE VA
22015
US

V. Phone/Fax

Practice location:
  • Phone: 703-425-5010
  • Fax: 410-706-0891
Mailing address:
  • Phone: 703-425-5010
  • Fax: 410-706-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0438000397
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberC1-0010973
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: