Provider Demographics
NPI:1295454916
Name:SHABEESH, MAREE
Entity type:Individual
Prefix:
First Name:MAREE
Middle Name:
Last Name:SHABEESH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 E TRENT AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-2376
Mailing Address - Country:US
Mailing Address - Phone:509-591-9959
Mailing Address - Fax:
Practice Address - Street 1:8901 E TRENT AVE STE 104
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-2376
Practice Address - Country:US
Practice Address - Phone:509-591-9959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61105787122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist