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General NPI Number Information
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NPI Number | 1174413264
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Entity Type | Individual
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Provider Name | SHAMIM SHAYEGAN RDH, EPDH
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Gender | Male
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Dates
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Enumeration Date | 07/09/2025
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 17189 SW JEAN LOUISE RD
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City | SHERWOOD
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State | OR
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Zip | 97140-9244
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Country | US
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Telephone | 971-762-7629
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Fax |
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Provider Business Mailing Address
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Address Line | 17189 SW JEAN LOUISE RD
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City | SHERWOOD
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State | OR
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Zip | 97140-9244
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Country | US
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Telephone | 971-762-7629
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Fax |
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | H8971
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License Number State | OR
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