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General NPI Number Information
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NPI Number | 1780012476
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Entity Type | Individual
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Provider Name | SHAGUNDEEP OCTAIN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 10/16/2013
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 1037 MADISON AVE N
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City | BAINBRIDGE ISLAND
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State | WA
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Zip | 98110-1727
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Country | US
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Telephone | 206-842-9890
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Fax |
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Provider Business Mailing Address
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Address Line | 21660 BARRINGTON DR
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City | WOODHAVEN
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State | MI
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Zip | 48183-1140
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Country | US
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Telephone | 734-707-8684
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1856315
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901021055
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE61157994
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License Number State | WA
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