Provider Demographics
NPI:1588268346
Name:AZITA SHAHGALDI, DMD LLC
Entity type:Organization
Organization Name:AZITA SHAHGALDI, DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AZITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHGALDI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-246-7999
Mailing Address - Street 1:9600 SW CAPITOL HWY STE 140
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5275
Mailing Address - Country:US
Mailing Address - Phone:503-246-7999
Mailing Address - Fax:503-546-2976
Practice Address - Street 1:9600 SW CAPITOL HWY STE 140
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-5275
Practice Address - Country:US
Practice Address - Phone:503-246-7999
Practice Address - Fax:503-546-2976
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AZITA SHAHGALDI, DMD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty