Healthcare Provider Details

I. General information

NPI: 1083188254
Provider Name (Legal Business Name): BILAL SHAMMOUT DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2019
Last Update Date: 01/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44215 15TH ST W STE 313
LANCASTER CA
93534-5505
US

IV. Provider business mailing address

44215 15TH ST W STE 313
LANCASTER CA
93534-5505
US

V. Phone/Fax

Practice location:
  • Phone: 661-948-2721
  • Fax: 661-948-4055
Mailing address:
  • Phone: 661-948-2721
  • Fax: 661-948-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: BILAL SHAMMOUT
Title or Position: PRESIDENT
Credential: DDS
Phone: 386-405-3934