Provider Demographics
NPI:1720314099
Name:SHAHRAM, SHOHREH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHOHREH
Middle Name:
Last Name:SHAHRAM
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 1:8605 WESTWOOD CENTER DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2240
Mailing Address - Country:US
Mailing Address - Phone:703-442-0770
Mailing Address - Fax:703-442-0771
Practice Address - Street 1:8605 WESTWOOD CENTER DR
Practice Address - Street 2:SUITE 210
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2240
Practice Address - Country:US
Practice Address - Phone:703-442-0770
Practice Address - Fax:703-442-0771
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14222122300000X
VA0401412160122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist