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General NPI Number Information
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NPI Number | 1710108683
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Entity Type | Individual
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Provider Name | SHIVA SHEIKHOLESLAM D.M.D., M.D.S.
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Gender | Female
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 731 ALTOS OAKS DR
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City | LOS ALTOS
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State | CA
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Zip | 94024-5402
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Country | US
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Telephone | 650-948-6884
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Fax | 650-948-7244
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Provider Business Mailing Address
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Address Line | 3236 OCTAVIA ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94123-2211
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Country | US
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Telephone | 415-374-7224
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Fax | 650-938-1999
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 54975
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License Number State | CA
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