Provider Demographics
NPI:1457409179
Name:SHABANY, TAREK (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAREK
Middle Name:
Last Name:SHABANY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 1ST ST
Mailing Address - Street 2:#1708
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-3400
Mailing Address - Country:US
Mailing Address - Phone:202-468-1226
Mailing Address - Fax:
Practice Address - Street 1:320 FIRST ST
Practice Address - Street 2:DENTAL CLINIC, BLDG 20
Practice Address - City:HOLLOMAN AFB
Practice Address - State:NM
Practice Address - Zip Code:88330-8006
Practice Address - Country:US
Practice Address - Phone:505-572-3742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist