Provider Demographics
NPI:1750633673
Name:I SMILE SIGNATURE DENTISTRY
Entity Type:Organization
Organization Name:I SMILE SIGNATURE DENTISTRY
Other - Org Name:S. SHAFI D.D.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAMSIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-412-1251
Mailing Address - Street 1:1601 E BAY DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-5616
Mailing Address - Country:US
Mailing Address - Phone:727-585-5675
Mailing Address - Fax:727-588-0114
Practice Address - Street 1:1601 E BAY DR
Practice Address - Street 2:SUITE 1
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-5616
Practice Address - Country:US
Practice Address - Phone:727-585-5675
Practice Address - Fax:727-588-0114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18338122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty