Provider Demographics
NPI:1699061069
Name:MOHIUDDIN, SUMAYRA MAIRAJ (DDS)
Entity type:Individual
Prefix:DR
First Name:SUMAYRA
Middle Name:MAIRAJ
Last Name:MOHIUDDIN
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 1:2101 KINGS LYNN RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-7506
Mailing Address - Country:US
Mailing Address - Phone:804-647-6004
Mailing Address - Fax:
Practice Address - Street 1:2101 KINGS LYNN RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-7506
Practice Address - Country:US
Practice Address - Phone:804-647-6004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014121961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice