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General NPI Number Information
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NPI Number | 1013403666
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Entity Type | Individual
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Provider Name | SHAHEEN SHAFAGH DMD
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Gender | Male
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Dates
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Enumeration Date | 07/06/2018
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Last Update Date | 01/28/2022
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Provider Practice Location Address
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Address Line | 100 S EAGLE RD
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City | HAVERTOWN
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State | PA
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Zip | 19083-3202
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Country | US
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Telephone | 104-466-6886
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Fax | 610-446-6844
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Provider Business Mailing Address
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Address Line | 125 FAIRVIEW RD
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City | PENN VALLEY
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State | PA
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Zip | 19072-1330
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Country | US
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Telephone | 610-733-8877
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Fax | 610-446-6844
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS042966
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN.00203680
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License Number State | CO
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