Provider Demographics
NPI:1952650509
Name:KAISER, AUDREY SHABNAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:SHABNAM
Last Name:KAISER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SHABNAM
Other - Middle Name:
Other - Last Name:RANJBAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1904 FRONT ST STE 530
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2583
Mailing Address - Country:US
Mailing Address - Phone:919-383-6661
Mailing Address - Fax:
Practice Address - Street 1:1904 FRONT ST
Practice Address - Street 2:STE 530
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705
Practice Address - Country:US
Practice Address - Phone:919-383-6661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9365122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist