Provider Demographics
NPI:1174413264
Name:SHAYEGAN, SHAMIM (RDH)
Entity type:Individual
Prefix:
First Name:SHAMIM
Middle Name:
Last Name:SHAYEGAN
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17189 SW JEAN LOUISE RD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9244
Mailing Address - Country:US
Mailing Address - Phone:971-762-7629
Mailing Address - Fax:
Practice Address - Street 1:17189 SW JEAN LOUISE RD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9244
Practice Address - Country:US
Practice Address - Phone:971-762-7629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH8971124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist