Provider Demographics
NPI:1275395725
Name:AL SHAFIEI, ALA (DDS)
Entity Type:Individual
Prefix:
First Name:ALA
Middle Name:
Last Name:AL SHAFIEI
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:PO BOX 15667
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-0667
Mailing Address - Country:US
Mailing Address - Phone:214-609-9040
Mailing Address - Fax:
Practice Address - Street 1:339 BLUE CAVERN PT
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-6813
Practice Address - Country:US
Practice Address - Phone:214-609-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN002058631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice