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General NPI Number Information
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NPI Number | 1023786969
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Entity Type | Individual
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Provider Name | SHERRY L BASHAM RDH
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Gender | Female
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Dates
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Enumeration Date | 09/04/2021
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Last Update Date | 09/04/2021
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Provider Practice Location Address
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Address Line | 3166 GOLANSKY BLVD
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City | WOODBRIDGE
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State | VA
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Zip | 22192-4263
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Country | US
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Telephone | 703-730-2931
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Fax |
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Provider Business Mailing Address
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Address Line | 15619 RHAME DR
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City | DUMFRIES
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State | VA
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Zip | 22025-1107
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Country | US
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Telephone | 703-878-7637
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 0402203521
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License Number State | VA
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