Provider Demographics
NPI:1679847800
Name:ASSAR, SHAWDI (DDS)
Entity Type:Individual
Prefix:
First Name:SHAWDI
Middle Name:
Last Name:ASSAR
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 1:413 UPHAM PL NW
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4126
Mailing Address - Country:US
Mailing Address - Phone:410-303-0555
Mailing Address - Fax:
Practice Address - Street 1:1477 CHAIN BRIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5729
Practice Address - Country:US
Practice Address - Phone:703-448-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413938122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist