MEDICARE: NADINE SHATAT DMD

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
1	1223G0001X	General Practice Dentistry	019032233	IL
2	1223G0001X	General Practice Dentistry	D011123	AZ

General Provider Information

NPI Number	:	1700448131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADINE SHATAT DMD

Provider Business Mailing Address
First Line	:	3402 W COCOPAH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85009-6723
Country	:	US
Telephone Number	:	602-352-0350
Fax Number	:

Provider Business Practice Location Address
First Line	:	3402 W COCOPAH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85009-6723
Country	:	US
Telephone Number	:	602-352-0350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2019
Last Update Date	:	03/05/2026

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Directions to “ NADINE SHATAT DMD” Practice Location

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