Provider Demographics
NPI:1972675809
Name:MULBERRY DENTAL CARE INC.
Entity Type:Organization
Organization Name:MULBERRY DENTAL CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARIBA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFII
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:863-869-8888
Mailing Address - Street 1:105 N CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:33860-2413
Mailing Address - Country:US
Mailing Address - Phone:863-869-8888
Mailing Address - Fax:863-869-8880
Practice Address - Street 1:105 N CHURCH AVE
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:FL
Practice Address - Zip Code:33860-2413
Practice Address - Country:US
Practice Address - Phone:863-869-8888
Practice Address - Fax:863-869-8880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN136631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN13663OtherDR. SHAFII'S LICENSE #
FLDN 13817OtherDR. FARZANEH'S LICENSE #
FLDN13663OtherDR. SHAFII'S LICENSE #