Provider Demographics
NPI:1710108683
Name:SHEIKHOLESLAM, SHIVA (DMD, MDS)
Entity Type:Individual
Prefix:DR
First Name:SHIVA
Middle Name:
Last Name:SHEIKHOLESLAM
Suffix:
Gender:F
Credentials:DMD, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3236 OCTAVIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-2211
Mailing Address - Country:US
Mailing Address - Phone:415-374-7224
Mailing Address - Fax:650-938-1999
Practice Address - Street 1:731 ALTOS OAKS DR
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5402
Practice Address - Country:US
Practice Address - Phone:650-948-6884
Practice Address - Fax:650-948-7244
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA549751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics