Provider Demographics
NPI:1568619724
Name:CROOM-MURIITHI, SHANI A (DDS)
Entity Type:Individual
Prefix:
First Name:SHANI
Middle Name:A
Last Name:CROOM-MURIITHI
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 1:6725 ANNAPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:LANDOVER HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1904
Mailing Address - Country:US
Mailing Address - Phone:301-773-4746
Mailing Address - Fax:
Practice Address - Street 1:6725 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:LANDOVER HILLS
Practice Address - State:MD
Practice Address - Zip Code:20784-1904
Practice Address - Country:US
Practice Address - Phone:301-773-4746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412103122300000X
DCDEN1000734122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist