Provider Demographics
NPI:1275763682
Name:SADAF, SHAHEEN (DMD)
Entity Type:Individual
Prefix:
First Name:SHAHEEN
Middle Name:
Last Name:SADAF
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3688 SEWELL MILL RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-5863
Mailing Address - Country:US
Mailing Address - Phone:305-281-6128
Mailing Address - Fax:
Practice Address - Street 1:27501 S DIXIE HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8235
Practice Address - Country:US
Practice Address - Phone:305-245-7733
Practice Address - Fax:305-248-7717
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 187001223G0001X
GADN0140471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice