Organization
SHAMMAA ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IMAD SHAMMAA DMD MS (OWNER)
(304) 925-4258
Entity
Organization
Contact information
Practice address
417 GRAND PARK DR STE 107, PARKERSBURG, WV 26105-4063
(304) 720-7771
(304) 925-4259
Mailing address
417 GRAND PARK DR STE 107, PARKERSBURG, WV 26105-4063
(304) 720-7771
(304) 925-4259
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
3192
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0077946000
—
WV
Enumeration date
04/03/2017
Last updated
05/02/2017
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