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General NPI Number Information
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NPI Number | 1043436579
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Entity Type | Individual
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Provider Name | IRAJ SHAFAGH DMD,MSC
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Gender | Male
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1305 WEST CHESTER PIKE SUITE C
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City | HAVERTOWN
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State | PA
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Zip | 19083-2935
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Country | US
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Telephone | 610-446-6688
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Fax | 610-446-6844
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Provider Business Mailing Address
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Address Line | 1305 W CHESTER PIKE
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City | HAVERTOWN
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State | PA
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Zip | 19083-2929
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Country | US
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Telephone | 610-446-6688
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DS-019264-L
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License Number State | PA
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