Provider Demographics
NPI:1154879732
Name:SHIREEN DHANANI DMD PA
Entity type:Organization
Organization Name:SHIREEN DHANANI DMD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DHANANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-231-9410
Mailing Address - Street 1:918 E DIXIE AVE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-7647
Mailing Address - Country:US
Mailing Address - Phone:321-231-9410
Mailing Address - Fax:407-905-6786
Practice Address - Street 1:918 E DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7647
Practice Address - Country:US
Practice Address - Phone:321-231-9410
Practice Address - Fax:407-905-6786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental