Provider Demographics
NPI:1043563661
Name:AMNA SHEBANI, D.D.S., P.C.
Entity Type:Organization
Organization Name:AMNA SHEBANI, D.D.S., P.C.
Other - Org Name:DENTISTRY FOR CHILDREN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:AMNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEBANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-260-0505
Mailing Address - Street 1:1405 S.E. 164TH AVENUE
Mailing Address - Street 2:SUITE # 203
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683
Mailing Address - Country:US
Mailing Address - Phone:360-260-0505
Mailing Address - Fax:360-260-0511
Practice Address - Street 1:1405 S.E. 164TH AVENUE
Practice Address - Street 2:SUITE # 203
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683
Practice Address - Country:US
Practice Address - Phone:360-260-0505
Practice Address - Fax:360-260-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty