Provider Demographics
NPI:1699598219
Name:AHMED, SHAYAN (DDS)
Entity type:Individual
Prefix:
First Name:SHAYAN
Middle Name:
Last Name:AHMED
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:N53W21824 TAYLORS WOODS DR
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-6258
Mailing Address - Country:US
Mailing Address - Phone:414-377-2563
Mailing Address - Fax:
Practice Address - Street 1:N53W21824 TAYLORS WOODS DR
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-6258
Practice Address - Country:US
Practice Address - Phone:414-377-2563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401416537122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist