Individual
DR. AFSANEH SAMATHA SHAHIDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4379 RIDGEWOOD CENTER DR, WOODBRIDGE, VA 22192-8322
(703) 680-7950
(703) 680-7953
Mailing address
4379 RIDGEWOOD CENTER DR STE 102, WOODBRIDGE, VA 22192-8323
(703) 680-7950
(703) 680-7953
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401415343
VA
1223G0001X
General Practice Dentistry
LL765
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119591300
—
MD
Enumeration date
07/13/2015
Last updated
03/20/2018
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