MEDICARE: SHIRIN YASREBI, DDS

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	1223P0221X	Pediatric Dentistry	DN5634	FL
2	1223P0221X	Pediatric Dentistry	DN12434	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427219773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIRIN YASREBI, DDS

Provider Business Mailing Address
First Line	:	2015 E EDGEWOOD DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-3601
Country	:	US
Telephone Number	:	863-667-9000
Fax Number	:	863-665-4368

Provider Business Practice Location Address
First Line	:	2015 E EDGEWOOD DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-3601
Country	:	US
Telephone Number	:	863-667-9000
Fax Number	:	863-665-4368

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. SHIRIN YASREBI
Credential	:	DDS
Telephone Number	:	863-667-9000

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	06/19/2008

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