Provider Demographics
NPI:1023364288
Name:SHIFTEH, SHAHNAM ALEXANDER (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAHNAM
Middle Name:ALEXANDER
Last Name:SHIFTEH
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 1:16 HOLIDAY CT
Mailing Address - Street 2:
Mailing Address - City:RIVER VALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-5708
Mailing Address - Country:US
Mailing Address - Phone:201-264-5270
Mailing Address - Fax:
Practice Address - Street 1:16 HOLIDAY CT
Practice Address - Street 2:
Practice Address - City:RIVER VALE
Practice Address - State:NJ
Practice Address - Zip Code:07675-5708
Practice Address - Country:US
Practice Address - Phone:201-264-5270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0561661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice