Provider Demographics
NPI:1891880126
Name:HAMID, GHADA T (DMD)
Entity Type:Individual
Prefix:
First Name:GHADA
Middle Name:T
Last Name:HAMID
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6230 E ROLLING RD
Mailing Address - Street 2:STE E
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:22152
Mailing Address - Country:US
Mailing Address - Phone:703-451-6100
Mailing Address - Fax:703-451-6185
Practice Address - Street 1:6230 E ROLLING RD
Practice Address - Street 2:STE E
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:22152
Practice Address - Country:US
Practice Address - Phone:703-451-6100
Practice Address - Fax:703-451-6185
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008277122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
960377OtherUNITED CONCORDIA
454037OtherBLUE CROSS BLUE SHIELD