Provider Demographics
NPI:1487868592
Name:SHAMLIAN, DENNIS EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:EDWARD
Last Name:SHAMLIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7077 N WEST AVE
Mailing Address - Street 2:#107
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-0669
Mailing Address - Country:US
Mailing Address - Phone:559-438-4646
Mailing Address - Fax:559-432-4326
Practice Address - Street 1:7077 N WEST AVE
Practice Address - Street 2:#107
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-0669
Practice Address - Country:US
Practice Address - Phone:559-438-4646
Practice Address - Fax:559-432-4326
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28812122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB2881201OtherDENTI CAL