Provider Demographics
NPI:1023418936
Name:SHAHNAVAZ, PARISA
Entity type:Individual
Prefix:
First Name:PARISA
Middle Name:
Last Name:SHAHNAVAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6233 W BEHREND DR
Mailing Address - Street 2:APT. 1038
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6970
Mailing Address - Country:US
Mailing Address - Phone:949-228-5124
Mailing Address - Fax:
Practice Address - Street 1:6233 W BEHREND DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6970
Practice Address - Country:US
Practice Address - Phone:949-228-5124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009079122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist