Provider Demographics
NPI:1699933549
Name:SHARIAT, SHABNAM (DR)
Entity type:Individual
Prefix:DR
First Name:SHABNAM
Middle Name:
Last Name:SHARIAT
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 SUTTER STREET, 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102
Mailing Address - Country:US
Mailing Address - Phone:415-781-6128
Mailing Address - Fax:415-781-3142
Practice Address - Street 1:520 SUTTER STREET, 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102
Practice Address - Country:US
Practice Address - Phone:415-781-6128
Practice Address - Fax:415-781-3142
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist