Provider Demographics
NPI:1538645353
Name:SHAYEGHI MARQUEZ, AMABELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMABELLE
Middle Name:
Last Name:SHAYEGHI MARQUEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2073 E FOX GLEN DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-4798
Mailing Address - Country:US
Mailing Address - Phone:559-304-9689
Mailing Address - Fax:
Practice Address - Street 1:3636 N 1ST ST STE 152
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-6818
Practice Address - Country:US
Practice Address - Phone:559-229-4536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-15
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102764122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist