Provider Demographics
NPI:1063153260
Name:WASSER, SHAINA RACHEL (DDS)
Entity type:Individual
Prefix:
First Name:SHAINA
Middle Name:RACHEL
Last Name:WASSER
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 1:12228 TRIPLE CROWN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-3785
Mailing Address - Country:US
Mailing Address - Phone:301-801-2211
Mailing Address - Fax:
Practice Address - Street 1:8393 LEESBURG PIKE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2402
Practice Address - Country:US
Practice Address - Phone:703-745-1797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002052231223G0001X
390200000X
VA04014192101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program