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General NPI Number Information
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NPI Number | 1508854985
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Entity Type | Individual
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Provider Name | SHAKILA BANU USMAN D.D.S
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Gender | Female
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 108 OLDE TOWNE AVE SUITE 8
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City | GAITHERSBURG
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State | MD
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Zip | 20877-2095
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Country | US
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Telephone | 301-519-8887
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Fax | 301-519-2706
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Provider Business Mailing Address
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Address Line | 17125 FLATWOOD DR
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City | ROCKVILLE
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State | MD
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Zip | 20855-2539
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Country | US
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Telephone | 301-963-8284
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 13107
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License Number State | MD
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