=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174957757
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHAHEEN RAJPARI UPTON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2013
-----------------------------------------------------
Last Update Date | 10/11/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1810 DECATUR HWY STE 212
-----------------------------------------------------
City | FULTONDALE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35068-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-821-1976
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1810 DECATUR HWY STE 212
-----------------------------------------------------
City | FULTONDALE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35068-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-874-9605
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SHAHEEN RAJPARI UPTON
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 205-874-9605
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 5916
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------