Provider Demographics
NPI:1689451072
Name:FAHEEM, SHANZAE ZAIN (BDS, MDS)
Entity Type:Individual
Prefix:DR
First Name:SHANZAE
Middle Name:ZAIN
Last Name:FAHEEM
Suffix:
Gender:F
Credentials:BDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 DENISE DR
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-3041
Mailing Address - Country:US
Mailing Address - Phone:346-775-1134
Mailing Address - Fax:
Practice Address - Street 1:12100 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-6908
Practice Address - Country:US
Practice Address - Phone:757-234-7572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014186391223X2210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X2210XDental ProvidersDentistOrofacial Pain