Provider Demographics
NPI:1639691330
Name:CHAVDA, SHEENA SHARIFZADEH (DMD)
Entity type:Individual
Prefix:DR
First Name:SHEENA
Middle Name:SHARIFZADEH
Last Name:CHAVDA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 DAVENPORT DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-0385
Mailing Address - Country:US
Mailing Address - Phone:404-451-6926
Mailing Address - Fax:
Practice Address - Street 1:1119 DRUID PARK AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5849
Practice Address - Country:US
Practice Address - Phone:706-737-6453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN122637122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist