Provider Demographics
NPI:1194074625
Name:TEHRANI, SHABNAM (DMD)
Entity type:Individual
Prefix:DR
First Name:SHABNAM
Middle Name:
Last Name:TEHRANI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19024 FERN MEADOW LOOP
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-4000
Mailing Address - Country:US
Mailing Address - Phone:813-727-0405
Mailing Address - Fax:
Practice Address - Street 1:7280 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6125
Practice Address - Country:US
Practice Address - Phone:727-807-3355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN198091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice