Provider Demographics
NPI:1194957258
Name:ANJUM, SHAZIA (DDS)
Entity type:Individual
Prefix:DR
First Name:SHAZIA
Middle Name:
Last Name:ANJUM
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 1:540 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-3171
Mailing Address - Country:US
Mailing Address - Phone:540-338-6262
Mailing Address - Fax:540-338-7054
Practice Address - Street 1:540 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-3171
Practice Address - Country:US
Practice Address - Phone:540-338-6262
Practice Address - Fax:540-338-7054
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412443122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist