Provider Demographics
NPI:1265648943
Name:SHAREGHI, SHADI (DDS)
Entity Type:Individual
Prefix:MISS
First Name:SHADI
Middle Name:
Last Name:SHAREGHI
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 1:3401 COMMISSION CT
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-1771
Mailing Address - Country:US
Mailing Address - Phone:703-494-7799
Mailing Address - Fax:703-494-2412
Practice Address - Street 1:3401 COMMISSION CT
Practice Address - Street 2:SUITE 202
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-1771
Practice Address - Country:US
Practice Address - Phone:703-494-7799
Practice Address - Fax:703-494-2412
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014107601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice