Basic Information
| Provider Information | |||||||||
| NPI: | 1063153260 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WASSER | ||||||||
| FirstName: | SHAINA | ||||||||
| MiddleName: | RACHEL | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12228 TRIPLE CROWN RD | ||||||||
| Address2: | |||||||||
| City: | NORTH POTOMAC | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208783785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018012211 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1860 E EGBERT ST | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806012404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036972583 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2022 | ||||||||
| LastUpdateDate: | 04/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.