Healthcare Provider Details

I. General information

NPI: 1497968333
Provider Name (Legal Business Name): BILAL SHAMMOUT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44215 15TH ST W UNIT 313
LANCASTER CA
93534-4014
US

IV. Provider business mailing address

44215 15TH ST W UNIT 313
LANCASTER CA
93534-4014
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number17888
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number00010685
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number60328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: