Provider Demographics
NPI:1780859504
Name:AMINPOUR SHAMASH, NAZITA (DDS)
Entity Type:Individual
Prefix:DR
First Name:NAZITA
Middle Name:
Last Name:AMINPOUR SHAMASH
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 1:51 ARLEIGH RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1442
Mailing Address - Country:US
Mailing Address - Phone:516-829-0585
Mailing Address - Fax:
Practice Address - Street 1:51 ARLEIGH RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1442
Practice Address - Country:US
Practice Address - Phone:516-482-7620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016456831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics