Provider Demographics
NPI:1164185419
Name:SHEKARI, SHAYAN
Entity Type:Individual
Prefix:
First Name:SHAYAN
Middle Name:
Last Name:SHEKARI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 EGLIN ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-9644
Mailing Address - Country:US
Mailing Address - Phone:605-877-3798
Mailing Address - Fax:
Practice Address - Street 1:1147 EGLIN ST # 57701
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-9644
Practice Address - Country:US
Practice Address - Phone:605-877-3798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2023-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002700122300000X
SDD1386122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist