Provider Demographics
NPI:1043436579
Name:SHAFAGH, IRAJ (DMD,MSC)
Entity type:Individual
Prefix:DR
First Name:IRAJ
Middle Name:
Last Name:SHAFAGH
Suffix:
Gender:M
Credentials:DMD,MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2929
Mailing Address - Country:US
Mailing Address - Phone:610-446-6688
Mailing Address - Fax:610-446-6844
Practice Address - Street 1:1305 WEST CHESTER PIKE
Practice Address - Street 2:SUITE C
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2935
Practice Address - Country:US
Practice Address - Phone:610-446-6688
Practice Address - Fax:610-446-6844
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-019264-L1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics