Provider Demographics
NPI:1679776843
Name:HUSSAIN, SHEHZAD (RDH)
Entity Type:Individual
Prefix:
First Name:SHEHZAD
Middle Name:
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S REYNOLDS ST APT 304
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4418
Mailing Address - Country:US
Mailing Address - Phone:703-407-3155
Mailing Address - Fax:309-413-4845
Practice Address - Street 1:3400 PAYNE ST STE 101
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-2313
Practice Address - Country:US
Practice Address - Phone:703-578-0000
Practice Address - Fax:703-578-8200
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402204169124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist