Provider Demographics
NPI:1770858565
Name:SHAFIEI, NIKKI (DDS)
Entity Type:Individual
Prefix:DR
First Name:NIKKI
Middle Name:
Last Name:SHAFIEI
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 1:407 MACARTHUR AVE NE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-3563
Mailing Address - Country:US
Mailing Address - Phone:703-297-1400
Mailing Address - Fax:
Practice Address - Street 1:555 S RANCHO SANTA FE RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-3698
Practice Address - Country:US
Practice Address - Phone:619-840-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA630071223P0221X
VA04014133851223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty