Provider Demographics
NPI:1275965543
Name:SHAHNAVAZ, ROXANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROXANA
Middle Name:
Last Name:SHAHNAVAZ
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 1:111 SW HARRISON ST
Mailing Address - Street 2:APT 12B
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5336
Mailing Address - Country:US
Mailing Address - Phone:415-987-3527
Mailing Address - Fax:
Practice Address - Street 1:111 SW HARRISON ST
Practice Address - Street 2:APT 12B
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5336
Practice Address - Country:US
Practice Address - Phone:415-987-3527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDD9935122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist