Provider Demographics
NPI:1518711191
Name:SHALABY PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:SHALABY PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALABY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-496-5713
Mailing Address - Street 1:24953 PASEO DE VALENCIA STE 2C
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4337
Mailing Address - Country:US
Mailing Address - Phone:949-496-5713
Mailing Address - Fax:
Practice Address - Street 1:24953 PASEO DE VALENCIA STE 2C
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4337
Practice Address - Country:US
Practice Address - Phone:949-496-5713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHALABY PROFESSIONAL DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty