Provider Demographics
NPI:1598347981
Name:SHOKOOHI, SHARAREH (DDS)
Entity type:Individual
Prefix:DR
First Name:SHARAREH
Middle Name:
Last Name:SHOKOOHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SHARAREH
Other - Middle Name:
Other - Last Name:SHOKOOHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1316 JACKIE RD SE STE 200
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1045
Mailing Address - Country:US
Mailing Address - Phone:505-994-9693
Mailing Address - Fax:
Practice Address - Street 1:1316 JACKIE RD SE STE 200
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1045
Practice Address - Country:US
Practice Address - Phone:505-994-9693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-25
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
NMTD-00-138390200000X
NMDD54611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program