Provider Demographics
NPI:1871763466
Name:SHAHRIYARPOUR AND SHAFAEE DENTAL PRACTICE INC.
Entity type:Organization
Organization Name:SHAHRIYARPOUR AND SHAFAEE DENTAL PRACTICE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFAEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-654-4654
Mailing Address - Street 1:15785 LAGUNA CANYON RD
Mailing Address - Street 2:SUITE #270
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3165
Mailing Address - Country:US
Mailing Address - Phone:949-654-4654
Mailing Address - Fax:949-654-4645
Practice Address - Street 1:15785 LAGUNA CANYON RD
Practice Address - Street 2:SUITE #270
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3165
Practice Address - Country:US
Practice Address - Phone:949-654-4654
Practice Address - Fax:949-654-4645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA492121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty