Provider Demographics
NPI:1780833087
Name:MARDINI, SHAZA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SHAZA
Middle Name:
Last Name:MARDINI
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 VIA VILLAGGIO
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-3788
Mailing Address - Country:US
Mailing Address - Phone:916-996-9969
Mailing Address - Fax:
Practice Address - Street 1:2745 VIA VILLAGGIO
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-3788
Practice Address - Country:US
Practice Address - Phone:916-996-9969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA489571223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology