Provider Demographics
NPI:1700661816
Name:SHAHID, OMAR (BDS, MDS, FRCDC)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:SHAHID
Suffix:
Gender:M
Credentials:BDS, MDS, FRCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 HAMPTON HWY
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-4948
Mailing Address - Country:US
Mailing Address - Phone:929-248-9669
Mailing Address - Fax:
Practice Address - Street 1:3212 HAMPTON HWY
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-4948
Practice Address - Country:US
Practice Address - Phone:929-248-9669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014185831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice