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NPI Code Detail

MEDICARE: SHAYESHEH & SHAMS WESTSIDE P A

MEDICARE: SHAYESHEH & SHAMS WESTSIDE P A
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1053659813
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHAYESHEH & SHAMS WESTSIDE P A
Provider Business Mailing Address
First Line : 255 SHADOW MOUNTAIN DR
Second Line : SUITE G AND H
City : EL PASO
State : TX
Zip : 79912-4757
Country : US
Telephone Number : 915-857-6453
Fax Number :
Provider Business Practice Location Address
First Line : 255 SHADOW MOUNTAIN DR
Second Line : SUITE G AND H
City : EL PASO
State : TX
Zip : 79912-4757
Country : US
Telephone Number : 915-857-6453
Fax Number :
Authorized Official
Title or Position : OWNER/DENTIST
Name : NIMA SHAYESTEH
Credential : D.M.D
Telephone Number : 915-857-6453
Provider Enumeration Date : 01/29/2013
Last Update Date : 01/29/2013

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Directions to “SHAYESHEH & SHAMS WESTSIDE P A ” Practice Location

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