Provider Demographics
NPI:1093790826
Name:ETEMADI, SHAHIN (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:SHAHIN
Middle Name:
Last Name:ETEMADI
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10025 19TH AVE SE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4275
Mailing Address - Country:US
Mailing Address - Phone:425-357-8747
Mailing Address - Fax:425-337-6190
Practice Address - Street 1:10025 19TH AVE SE
Practice Address - Street 2:STE 202
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4275
Practice Address - Country:US
Practice Address - Phone:425-357-8747
Practice Address - Fax:425-337-6190
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000101671223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics