Healthcare Provider Details

I. General information

NPI: 1083007744
Provider Name (Legal Business Name): ZAINAH M SHAKER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 113TH AVE NE STE 400B
BLAINE MN
55434-3874
US

IV. Provider business mailing address

1351 113TH AVE NE STE 400B
BLAINE MN
55434-3874
US

V. Phone/Fax

Practice location:
  • Phone: 763-415-1222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6002286-15
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.034271
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD13530
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: