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General NPI Number Information
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NPI Number | 1417283078
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Entity Type | Organization
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Legal Business Name | SHAMS AND NABIZADEH DENTAL CORPORATION
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Dates
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Enumeration Date | 11/02/2009
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Last Update Date | 11/02/2009
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Provider Practice Location Address
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Address Line | 7111 WINNETKA AVE SUITE #3
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City | WINNETKA
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State | CA
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Zip | 91306-3646
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Country | US
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Telephone | 818-676-0970
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Fax |
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Provider Business Mailing Address
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Address Line | 7111 WINNETKA AVE SUITE #3
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City | WINNETKA
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State | CA
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Zip | 91306-3646
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Country | US
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Telephone | 818-676-0970
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | TAMIR NISAN SHAMS
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Credential | DMD
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Telephone | 818-676-0970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 56220
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 56712
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License Number State | CA
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