Provider Demographics
NPI:1144656356
Name:MERDAD, HISHAM ESSAM A (BDS, DSCD)
Entity type:Individual
Prefix:
First Name:HISHAM
Middle Name:ESSAM A
Last Name:MERDAD
Suffix:
Gender:M
Credentials:BDS, DSCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6537 ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-3001
Mailing Address - Country:US
Mailing Address - Phone:703-536-2661
Mailing Address - Fax:703-538-3424
Practice Address - Street 1:6537 ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3001
Practice Address - Country:US
Practice Address - Phone:703-536-2661
Practice Address - Fax:703-538-3424
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014143521223P0221X
MI29010208261223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry