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General NPI Number Information
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NPI Number | 1427219773
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Entity Type | Organization
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Legal Business Name | SHIRIN YASREBI, DDS
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Dates
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Enumeration Date | 06/19/2008
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 2015 E EDGEWOOD DR
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City | LAKELAND
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State | FL
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Zip | 33803-3601
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Country | US
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Telephone | 863-667-9000
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Fax | 863-665-4368
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Provider Business Mailing Address
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Address Line | 2015 E EDGEWOOD DR
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City | LAKELAND
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State | FL
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Zip | 33803-3601
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Country | US
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Telephone | 863-667-9000
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Fax | 863-665-4368
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SHIRIN YASREBI
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Credential | DDS
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Telephone | 863-667-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN5634
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN12434
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License Number State | FL
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