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General NPI Number Information
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NPI Number | 1366865248
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Entity Type | Organization
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Legal Business Name | IDEAL SMILES FAMILY & COSMETIC DENTISTRY
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Dates
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Enumeration Date | 01/28/2014
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Last Update Date | 01/28/2014
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Provider Practice Location Address
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Address Line | 367 INDEPENDENCE BLVD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-2822
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Country | US
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Telephone | 757-962-7000
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Fax | 757-962-9335
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Provider Business Mailing Address
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Address Line | 367 INDEPENDENCE BLVD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-2822
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Country | US
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Telephone | 757-962-7000
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Fax | 757-962-9335
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHABANA ZAHIR
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Credential | DMD
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Telephone | 757-962-7000
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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 | 0401412167
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License Number State | VA
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