Provider Demographics
NPI:1225172968
Name:IRANINEJAD, SHABNAM O (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHABNAM
Middle Name:O
Last Name:IRANINEJAD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:
Other - Last Name:OMID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4305 TORRANCE BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4409
Mailing Address - Country:US
Mailing Address - Phone:310-542-5155
Mailing Address - Fax:310-542-5118
Practice Address - Street 1:4305 TORRANCE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4409
Practice Address - Country:US
Practice Address - Phone:310-542-5155
Practice Address - Fax:310-542-5118
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice