Provider Demographics
NPI:1659452357
Name:SHAHLAIE, MASIH (BDS, MS)
Entity type:Individual
Prefix:DR
First Name:MASIH
Middle Name:
Last Name:SHAHLAIE
Suffix:
Gender:M
Credentials:BDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16283 N 99TH WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2239
Mailing Address - Country:US
Mailing Address - Phone:480-747-1969
Mailing Address - Fax:480-361-3074
Practice Address - Street 1:16944 W BELL RD
Practice Address - Street 2:SUITE B-1
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8950
Practice Address - Country:US
Practice Address - Phone:623-214-5518
Practice Address - Fax:623-214-5572
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD57131223P0300X
NY0504391223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics