Provider Demographics
NPI:1164777173
Name:SAMRA, CHRISTINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:
Last Name:SAMRA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 LANDON HILL RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-1853
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2936 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-3003
Practice Address - Country:US
Practice Address - Phone:703-255-1150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014136521223G0001X
MD150701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice