Provider Demographics
NPI:1790857191
Name:SHAKOORI, BEHNAZ (DMD)
Entity Type:Individual
Prefix:DR
First Name:BEHNAZ
Middle Name:
Last Name:SHAKOORI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 HANOVER PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2008
Mailing Address - Country:US
Mailing Address - Phone:301-474-1110
Mailing Address - Fax:301-474-1008
Practice Address - Street 1:7600 HANOVER PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2008
Practice Address - Country:US
Practice Address - Phone:301-474-1110
Practice Address - Fax:301-474-1008
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD126461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice