Healthcare Provider Details

I. General information

NPI: 1588731186
Provider Name (Legal Business Name): ABRAHAM SHAIT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 SKIPWITH RD SUITE D
RICHMOND VA
23294-4443
US

IV. Provider business mailing address

3210 SKIPWITH RD SUITE D
RICHMOND VA
23294-4443
US

V. Phone/Fax

Practice location:
  • Phone: 804-270-7070
  • Fax: 804-270-0277
Mailing address:
  • Phone: 804-270-7070
  • Fax: 804-270-0277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number05226
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: