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General NPI Number Information
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NPI Number | 1679776843
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Entity Type | Individual
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Provider Name | SHEHZAD HUSSAIN RDH
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Gender | Male
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3400 PAYNE ST STE 101
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City | FALLS CHURCH
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State | VA
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Zip | 22041-2313
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Country | US
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Telephone | 703-578-0000
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Fax | 703-578-8200
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Provider Business Mailing Address
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Address Line | 250 S REYNOLDS ST APT 304
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City | ALEXANDRIA
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State | VA
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Zip | 22304-4418
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Country | US
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Telephone | 703-407-3155
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Fax | 309-413-4845
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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 | 0402204169
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License Number State | VA
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