Provider Demographics
NPI:1396095956
Name:QURBAN, SHAFAQ (DDS)
Entity type:Individual
Prefix:DR
First Name:SHAFAQ
Middle Name:
Last Name:QURBAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6260 STONERIDGE MALL RD
Mailing Address - Street 2:A218
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3245
Mailing Address - Country:US
Mailing Address - Phone:201-919-1647
Mailing Address - Fax:
Practice Address - Street 1:6260 STONERIDGE MALL RD
Practice Address - Street 2:A218
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3245
Practice Address - Country:US
Practice Address - Phone:201-919-1647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61749122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist