Individual
DR. IMAD SHAMMAA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD MS
Contact information
Practice address
3920 MACCORKLE AVE SE, CHARLESTON, WV 25304
(304) 925-4258
(304) 925-4259
Mailing address
3920 MACCORKLE AVE SE, CHARLESTON, WV 25304
(304) 925-4258
(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
12/04/2006
Last updated
07/08/2007
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