Provider Demographics
NPI:1003975459
Name:SHAFIEI, PADIDEH (DMD)
Entity Type:Individual
Prefix:
First Name:PADIDEH
Middle Name:
Last Name:SHAFIEI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6865 ALTON PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3739
Mailing Address - Country:US
Mailing Address - Phone:949-246-0944
Mailing Address - Fax:
Practice Address - Street 1:6865 ALTON PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3739
Practice Address - Country:US
Practice Address - Phone:949-246-0944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA498031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice