Provider Demographics
NPI:1376547232
Name:QAZI, SHAHIDA (DDS, FAGD)
Entity Type:Individual
Prefix:DR
First Name:SHAHIDA
Middle Name:
Last Name:QAZI
Suffix:
Gender:F
Credentials:DDS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-2127
Mailing Address - Country:US
Mailing Address - Phone:607-753-1843
Mailing Address - Fax:607-753-0938
Practice Address - Street 1:84 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-2127
Practice Address - Country:US
Practice Address - Phone:607-753-1843
Practice Address - Fax:607-753-0938
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
NY036627-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice