Provider Demographics
NPI:1902011497
Name:GHOBADI, SHAHIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHAHIN
Middle Name:
Last Name:GHOBADI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 HARRISON AVE.
Mailing Address - Street 2:STE 101
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543
Mailing Address - Country:US
Mailing Address - Phone:914-698-4090
Mailing Address - Fax:914-698-2195
Practice Address - Street 1:1600 HARRISON AVE
Practice Address - Street 2:STE 101
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543
Practice Address - Country:US
Practice Address - Phone:914-698-4090
Practice Address - Fax:914-698-2195
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02332400122300000X
NY0538651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist