Provider Demographics
NPI:1194997031
Name:SHAHNAZ SABER, DDS PA
Entity type:Organization
Organization Name:SHAHNAZ SABER, DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:SHAHNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SABER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:443-747-0341
Mailing Address - Street 1:4 WEST ROLLING CROSSROADS
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-6278
Mailing Address - Country:US
Mailing Address - Phone:410-747-0341
Mailing Address - Fax:410-747-2437
Practice Address - Street 1:4 WEST ROLLING CROSSROADS
Practice Address - Street 2:SUITE 5
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-6278
Practice Address - Country:US
Practice Address - Phone:410-747-0341
Practice Address - Fax:410-747-2437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12112261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4085175 00Medicaid