Provider Demographics
NPI:1083821938
Name:IQBAL, SHAZIA (DDS)
Entity Type:Individual
Prefix:
First Name:SHAZIA
Middle Name:
Last Name:IQBAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SHAZIA
Other - Middle Name:
Other - Last Name:RANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5412 WATERLILY DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5214
Mailing Address - Country:US
Mailing Address - Phone:925-351-4991
Mailing Address - Fax:925-351-4991
Practice Address - Street 1:123 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-1809
Practice Address - Country:US
Practice Address - Phone:925-351-4991
Practice Address - Fax:925-351-4991
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232061223G0001X
CA548951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice