Provider Demographics
NPI:1669049722
Name:BASHIR, SUNNA (DDS)
Entity type:Individual
Prefix:
First Name:SUNNA
Middle Name:
Last Name:BASHIR
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 1:6307 KNOLLS POND LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-1654
Mailing Address - Country:US
Mailing Address - Phone:703-463-6148
Mailing Address - Fax:
Practice Address - Street 1:9901 FAIRFAX BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-1740
Practice Address - Country:US
Practice Address - Phone:703-348-4216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0431991223P0221X
VA04014175781223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty