Provider Demographics
NPI:1053659813
Name:SHAYESHEH & SHAMS WESTSIDE P A
Entity Type:Organization
Organization Name:SHAYESHEH & SHAMS WESTSIDE P A
Other - Org Name:PICASSO SMILES DENTAL IMPLANT & COSMETIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAYESTEH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:915-857-6453
Mailing Address - Street 1:255 SHADOW MOUNTAIN DR
Mailing Address - Street 2:SUITE G AND H
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4757
Mailing Address - Country:US
Mailing Address - Phone:915-857-6453
Mailing Address - Fax:
Practice Address - Street 1:255 SHADOW MOUNTAIN DR
Practice Address - Street 2:SUITE G AND H
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4757
Practice Address - Country:US
Practice Address - Phone:915-857-6453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAYESTEH & SHAMS P A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty