Provider Demographics
NPI:1598347981
Name:SHOKOOHI, SHARAREH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHARAREH
Middle Name:
Last Name:SHOKOOHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SHARAREH
Other - Middle Name:
Other - Last Name:SHOKOOHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:MSC (DENTISTRY) 1 UNIVERSITY OF NEW MEXICO
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MSC (DENTISTRY) 1 UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-3351
Practice Address - Country:US
Practice Address - Phone:505-925-7699
Practice Address - Fax:505-925-4030
Is Sole Proprietor?:No
Enumeration Date:2021-04-25
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
NMTD-00-138390200000X
NMDD54611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program