Provider Demographics
NPI:1548456106
Name:BETHEL, SHIRLEY F (DMD)
Entity type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:F
Last Name:BETHEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4229 LAFAYETTE CENTER DR
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1261
Mailing Address - Country:US
Mailing Address - Phone:703-378-2000
Mailing Address - Fax:703-378-2400
Practice Address - Street 1:4229 LAFAYETTE CENTER DR
Practice Address - Street 2:SUITE 1400
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1261
Practice Address - Country:US
Practice Address - Phone:703-378-2000
Practice Address - Fax:703-378-2400
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010075211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry