Provider Demographics
NPI:1063549483
Name:NADIR-MOHAMMADI, SHAHLA (DDS)
Entity type:Individual
Prefix:MRS
First Name:SHAHLA
Middle Name:
Last Name:NADIR-MOHAMMADI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20429 YORBA LINDA BLVD
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3042
Mailing Address - Country:US
Mailing Address - Phone:714-695-9530
Mailing Address - Fax:714-695-9521
Practice Address - Street 1:20429 YORBA LINDA BLVD
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-3042
Practice Address - Country:US
Practice Address - Phone:714-695-9530
Practice Address - Fax:714-695-9521
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44744122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist