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General NPI Number Information
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NPI Number | 1205546108
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Entity Type | Organization
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Legal Business Name | MICHELLE SHAMARDI, DDS A DENTAL CORPORATION
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Dates
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Enumeration Date | 12/01/2022
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 400 NEWPORT CENTER DR STE 209
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7645
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Country | US
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Telephone | 949-760-1051
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Fax | 949-760-2654
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Provider Business Mailing Address
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Address Line | 400 NEWPORT CENTER DR STE 209
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7645
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Country | US
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Telephone | 949-760-1051
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHELLE M. SHAMARDI
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Credential | DDS
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Telephone | 949-760-1051
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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 |
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License Number State |
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