Provider Demographics
NPI:1831305010
Name:RASUL, MAMOONA SHAZIA (DDS)
Entity Type:Individual
Prefix:MS
First Name:MAMOONA
Middle Name:SHAZIA
Last Name:RASUL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MAMOONA
Other - Middle Name:
Other - Last Name:SHAZIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 N SHENANDOAH CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-9664
Mailing Address - Country:US
Mailing Address - Phone:909-213-7062
Mailing Address - Fax:559-334-2012
Practice Address - Street 1:3206 N DINUBA BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-8729
Practice Address - Country:US
Practice Address - Phone:909-213-7062
Practice Address - Fax:559-334-2012
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA554021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92150-14OtherHEALTHY FAMILIES
CAG92150-14OtherSTATE GOV. DENTICAL