Provider Demographics
NPI:1437388634
Name:SHAKIBA, HOOMAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:HOOMAN
Middle Name:
Last Name:SHAKIBA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 SE 136TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6908
Mailing Address - Country:US
Mailing Address - Phone:360-896-9595
Mailing Address - Fax:360-896-9703
Practice Address - Street 1:217 SE 136TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6908
Practice Address - Country:US
Practice Address - Phone:360-896-9595
Practice Address - Fax:360-896-9703
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60242017122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist