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General NPI Number Information
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NPI Number | 1053607796
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Entity Type | Organization
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Legal Business Name | SHAYESTEH AND SHAMS DENTAL PA
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Dates
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Enumeration Date | 06/21/2011
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Last Update Date | 06/21/2011
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Provider Practice Location Address
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Address Line | 1816 N ZARAGOZA RD STE 103
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City | EL PASO
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State | TX
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Zip | 79936-8020
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Country | US
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Telephone | 310-663-4323
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Fax |
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Provider Business Mailing Address
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Address Line | 1816 N ZARAGOZA RD STE 103
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City | EL PASO
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State | TX
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Zip | 79936-8020
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | TAMIR SHAMS
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Credential | D.M.D
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Telephone | 310-663-4323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 24979
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 26280
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License Number State | TX
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