Provider Demographics
NPI:1194566299
Name:CHHABRA, SAMANTHA (DDS)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:CHHABRA
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 1:8606 MALLARD VW
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-3314
Mailing Address - Country:US
Mailing Address - Phone:703-861-8792
Mailing Address - Fax:
Practice Address - Street 1:9945 HULL STREET RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-1412
Practice Address - Country:US
Practice Address - Phone:804-335-0599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014189241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice