Provider Demographics
NPI:1093116824
Name:ASGARI, SHADOW (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHADOW
Middle Name:
Last Name:ASGARI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 W RAY RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-5940
Mailing Address - Country:US
Mailing Address - Phone:480-812-8200
Mailing Address - Fax:480-812-8552
Practice Address - Street 1:3336 E CHANDLER HEIGHTS RD
Practice Address - Street 2:BLDG 2 SUITE 111
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-4259
Practice Address - Country:US
Practice Address - Phone:480-988-0028
Practice Address - Fax:480-988-6414
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD05715122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist