MEDICARE: SHAYESHEH & SHAMS WESTSIDE P A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1053659813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAYESHEH & SHAMS WESTSIDE P A

Provider Business Mailing Address
First Line	:	255 SHADOW MOUNTAIN DR
Second Line	:	SUITE G AND H
City	:	EL PASO
State	:	TX
Zip	:	79912-4757
Country	:	US
Telephone Number	:	915-857-6453
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 SHADOW MOUNTAIN DR
Second Line	:	SUITE G AND H
City	:	EL PASO
State	:	TX
Zip	:	79912-4757
Country	:	US
Telephone Number	:	915-857-6453
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	NIMA SHAYESTEH
Credential	:	D.M.D
Telephone Number	:	915-857-6453

Provider Enumeration Date	:	01/29/2013
Last Update Date	:	01/29/2013

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