Provider Demographics
NPI:1851518914
Name:NEJATI, SHABNAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHABNAM
Middle Name:
Last Name:NEJATI
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 1:26700 TOWNE CENTRE DR
Mailing Address - Street 2:SUITE #160
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-2844
Mailing Address - Country:US
Mailing Address - Phone:949-581-1500
Mailing Address - Fax:949-581-1511
Practice Address - Street 1:26700 TOWNE CENTRE DR
Practice Address - Street 2:SUITE #160
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-2844
Practice Address - Country:US
Practice Address - Phone:949-581-1500
Practice Address - Fax:949-581-1511
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA528991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice