Provider Demographics
NPI:1508854985
Name:USMAN, SHAKILA BANU (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAKILA
Middle Name:BANU
Last Name:USMAN
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 1:17125 FLATWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-2539
Mailing Address - Country:US
Mailing Address - Phone:301-963-8284
Mailing Address - Fax:
Practice Address - Street 1:108 OLDE TOWNE AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2095
Practice Address - Country:US
Practice Address - Phone:301-519-8887
Practice Address - Fax:301-519-2706
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13107122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist