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General NPI Number Information
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NPI Number | 1679847800
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Entity Type | Individual
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Provider Name | SHAWDI ASSAR D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 03/06/2012
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Last Update Date | 01/15/2019
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Provider Practice Location Address
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Address Line | 1477 CHAIN BRIDGE RD STE 101
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City | MC LEAN
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State | VA
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Zip | 22101-5729
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Country | US
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Telephone | 703-448-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 413 UPHAM PL NW
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City | VIENNA
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State | VA
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Zip | 22180-4126
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Country | US
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Telephone | 410-303-0555
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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 | 0401413938
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License Number State | VA
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