Provider Demographics
NPI:1205919768
Name:HIJAB, DAVID S (DDS, PA)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:HIJAB
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13106 WINCHESTER RD SW
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6035
Mailing Address - Country:US
Mailing Address - Phone:301-729-1000
Mailing Address - Fax:301-729-0500
Practice Address - Street 1:13106 WINCHESTER RD SW
Practice Address - Street 2:
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-6035
Practice Address - Country:US
Practice Address - Phone:301-729-1000
Practice Address - Fax:301-729-0500
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD129191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1303248OtherUNITED CONCORDIA PROVIDER
MDZZPKDAOtherCFMI DENTAL NUMBER
MD204046042001OtherCAREFIRST BCBS REGIONAL #