Provider Demographics
NPI:1558900555
Name:SANAZ SHAHBANDI DDS A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SANAZ SHAHBANDI DDS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SANAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHBANDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-267-1515
Mailing Address - Street 1:6449 E SAINT GERMAIN CIR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-4348
Mailing Address - Country:US
Mailing Address - Phone:630-267-1515
Mailing Address - Fax:
Practice Address - Street 1:845 W LA VETA AVE STE 109
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3930
Practice Address - Country:US
Practice Address - Phone:714-639-6410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty