Provider Demographics
NPI:1962198374
Name:JAHANPANAH, SHAYAN
Entity type:Individual
Prefix:
First Name:SHAYAN
Middle Name:
Last Name:JAHANPANAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 HYACINTH RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1757
Mailing Address - Country:US
Mailing Address - Phone:513-262-3438
Mailing Address - Fax:
Practice Address - Street 1:8020 NORTHLAKE CREEK DR STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-4487
Practice Address - Country:US
Practice Address - Phone:704-264-1441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13334122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist