=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205919768
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID S HIJAB D.D.S, P.A.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13106 WINCHESTER RD SW
-----------------------------------------------------
City | LAVALE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21502-6035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-729-1000
-----------------------------------------------------
Fax | 301-729-0500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13106 WINCHESTER RD SW
-----------------------------------------------------
City | LAVALE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21502-6035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-729-1000
-----------------------------------------------------
Fax | 301-729-0500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 12919
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------