Provider Demographics
NPI:1528283975
Name:SHAFIE, HAMID REZA (DDS CAGS)
Entity type:Individual
Prefix:DR
First Name:HAMID
Middle Name:REZA
Last Name:SHAFIE
Suffix:
Gender:M
Credentials:DDS CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 21ST ST NW
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-5947
Mailing Address - Country:US
Mailing Address - Phone:202-331-3476
Mailing Address - Fax:202-331-3475
Practice Address - Street 1:1426 21ST ST NW
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-5947
Practice Address - Country:US
Practice Address - Phone:202-331-3476
Practice Address - Fax:202-331-3475
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN 57641223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics