Healthcare Provider Details

I. General information

NPI: 1023156775
Provider Name (Legal Business Name): SHAHRAM NABIPOUR DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W 92ND ST APT 2
NEW YORK NY
10025-7583
US

IV. Provider business mailing address

121 W 92ND ST APT 2
NEW YORK NY
10025-7583
US

V. Phone/Fax

Practice location:
  • Phone: 415-310-2848
  • Fax:
Mailing address:
  • Phone: 415-310-2848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number058928
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: