Provider Demographics
NPI:1922170471
Name:WITTING, FEDRA SHAFAIE (D D S)
Entity Type:Individual
Prefix:DR
First Name:FEDRA
Middle Name:SHAFAIE
Last Name:WITTING
Suffix:
Gender:F
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 ADMIRAL COCHRANE DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:410-841-5400
Mailing Address - Fax:410-266-3151
Practice Address - Street 1:175 ADMIRAL COCHRANE DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-841-5400
Practice Address - Fax:410-266-3151
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11355122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist