Provider Demographics
NPI:1639805476
Name:JAVIDI, SHAHIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHAHIN
Middle Name:
Last Name:JAVIDI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N 2ND AVE APT 414
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-3509
Mailing Address - Country:US
Mailing Address - Phone:925-285-9105
Mailing Address - Fax:
Practice Address - Street 1:4491 W NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-1649
Practice Address - Country:US
Practice Address - Phone:623-931-5321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011483122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist