Provider Demographics
NPI:1215190954
Name:BANGASH, SHAZMEENA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAZMEENA
Middle Name:
Last Name:BANGASH
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 1:3203 SPIDER LILY
Mailing Address - Street 2:
Mailing Address - City:SMITHS GROVE
Mailing Address - State:TX
Mailing Address - Zip Code:78258
Mailing Address - Country:US
Mailing Address - Phone:559-301-8276
Mailing Address - Fax:
Practice Address - Street 1:141 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHS GROVE
Practice Address - State:KY
Practice Address - Zip Code:42171-8130
Practice Address - Country:US
Practice Address - Phone:270-451-0059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6130111-9922122300000X
TX318361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist