Provider Demographics
NPI:1689718421
Name:SHASHATY, NADINE (DDS)
Entity Type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:
Last Name:SHASHATY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14860 ROSCOE BLVD
Mailing Address - Street 2:SUITE #207
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4665
Mailing Address - Country:US
Mailing Address - Phone:818-904-0008
Mailing Address - Fax:818-904-0077
Practice Address - Street 1:14860 ROSCOE BLVD
Practice Address - Street 2:SUITE #207
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4665
Practice Address - Country:US
Practice Address - Phone:818-904-0008
Practice Address - Fax:818-904-0077
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD480161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD48016OtherLICENCE NUMBER
CA364569184OtherTAX ID NUMBER
CAG93520-01Medicare ID - Type UnspecifiedPROVIDER NUMBER