Provider Demographics
NPI:1669145967
Name:TAMBAWALA, SHAHNAZ (DDS)
Entity type:Individual
Prefix:
First Name:SHAHNAZ
Middle Name:
Last Name:TAMBAWALA
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 1:22750 HARMONY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-5857
Mailing Address - Country:US
Mailing Address - Phone:323-363-3465
Mailing Address - Fax:
Practice Address - Street 1:27661 BOUQUET CANYON RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-1793
Practice Address - Country:US
Practice Address - Phone:661-347-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1065531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice