Provider Demographics
NPI:1689304065
Name:ALSHAMMARI, ZAID SAAD FLAYYIH
Entity Type:Individual
Prefix:
First Name:ZAID
Middle Name:SAAD FLAYYIH
Last Name:ALSHAMMARI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 LINCOLN CIR APT 145
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-5934
Mailing Address - Country:US
Mailing Address - Phone:479-445-7321
Mailing Address - Fax:
Practice Address - Street 1:825 WARRENTON RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-3545
Practice Address - Country:US
Practice Address - Phone:479-445-7321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014181651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VANAMedicaid