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General NPI Number Information
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NPI Number | 1770858565
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Entity Type | Individual
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Provider Name | NIKKI SHAFIEI D.D.S
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Gender | Female
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 05/20/2020
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Provider Practice Location Address
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Address Line | 555 S RANCHO SANTA FE RD STE 101
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City | SAN MARCOS
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State | CA
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Zip | 92078-3698
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Country | US
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Telephone | 619-840-4848
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Fax |
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Provider Business Mailing Address
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Address Line | 407 MACARTHUR AVE NE
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City | VIENNA
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State | VA
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Zip | 22180-3563
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Country | US
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Telephone | 703-297-1400
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Fax |
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 63007
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License Number State | CA
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