Provider Demographics
NPI:1518137439
Name:SHAHZAD, KHURRAM MUHAMMAD (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:KHURRAM
Middle Name:MUHAMMAD
Last Name:SHAHZAD
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GREEN VALLEY ORAL SURGERY AND DENTAL IMPLANT CENTER
Mailing Address - Street 2:5140 BUSINESS CENTER DRIVE SUITE 120
Mailing Address - City:FAIRFILED
Mailing Address - State:CA
Mailing Address - Zip Code:94534
Mailing Address - Country:US
Mailing Address - Phone:707-314-3282
Mailing Address - Fax:
Practice Address - Street 1:GREEN VALLEY ORAL SURGERY AND DENTAL IMPLANT CENTER
Practice Address - Street 2:5140 BUSINESS CENTER DRIVE SUITE 120
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534
Practice Address - Country:US
Practice Address - Phone:707-314-3282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050506-1122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist