Provider Demographics
NPI:1124209408
Name:SHIRAZY, HAMIDA (DMD)
Entity Type:Individual
Prefix:
First Name:HAMIDA
Middle Name:
Last Name:SHIRAZY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PRESIDENTIAL BLVD
Mailing Address - Street 2:SUITE#303
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1006
Mailing Address - Country:US
Mailing Address - Phone:610-660-9510
Mailing Address - Fax:610-660-9512
Practice Address - Street 1:15 PRESIDENTIAL BLVD
Practice Address - Street 2:SUITE#303
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1006
Practice Address - Country:US
Practice Address - Phone:610-660-9510
Practice Address - Fax:610-660-9512
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0372221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice