Provider Demographics
NPI:1639374762
Name:SHAMI, IMAD (DMD, OMFS)
Entity Type:Individual
Prefix:DR
First Name:IMAD
Middle Name:
Last Name:SHAMI
Suffix:
Gender:M
Credentials:DMD, OMFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7001
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-0001
Mailing Address - Country:US
Mailing Address - Phone:215-740-5666
Mailing Address - Fax:
Practice Address - Street 1:159 HILLWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046
Practice Address - Country:US
Practice Address - Phone:703-531-0010
Practice Address - Fax:703-531-1330
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04380002721223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery