Provider Demographics
NPI:1417283078
Name:SHAMS AND NABIZADEH DENTAL CORPORATION
Entity Type:Organization
Organization Name:SHAMS AND NABIZADEH DENTAL CORPORATION
Other - Org Name:WINNETKA DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMIR
Authorized Official - Middle Name:NISAN
Authorized Official - Last Name:SHAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:818-676-0970
Mailing Address - Street 1:7111 WINNETKA AVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-3646
Mailing Address - Country:US
Mailing Address - Phone:818-676-0970
Mailing Address - Fax:
Practice Address - Street 1:7111 WINNETKA AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-3646
Practice Address - Country:US
Practice Address - Phone:818-676-0970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56712302R00000X
CA56220302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization