Provider Demographics
NPI:1972254902
Name:SHAYEGH AND KHANNA DDS PLLC
Entity Type:Organization
Organization Name:SHAYEGH AND KHANNA DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MEYSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAYEGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-633-2088
Mailing Address - Street 1:2240 COLISEUM DR STE C
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5903
Mailing Address - Country:US
Mailing Address - Phone:757-826-1121
Mailing Address - Fax:
Practice Address - Street 1:2240 COLISEUM DR STE C
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5903
Practice Address - Country:US
Practice Address - Phone:757-826-1121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty