Provider Demographics
NPI:1164588778
Name:SHEBANI, AMNA (DDS)
Entity Type:Individual
Prefix:
First Name:AMNA
Middle Name:
Last Name:SHEBANI
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 1:1405 SE 164TH AVE
Mailing Address - Street 2:SUITE# 203
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9644
Mailing Address - Country:US
Mailing Address - Phone:360-260-0505
Mailing Address - Fax:360-260-0511
Practice Address - Street 1:1405 SE 164TH AVE
Practice Address - Street 2:SUITE# 203
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9644
Practice Address - Country:US
Practice Address - Phone:360-260-0505
Practice Address - Fax:360-260-0511
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE85931223P0221X
ORD76751223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry