Provider Demographics
NPI:1700448131
Name:SHATAT, NADINE (DMD)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:SHATAT
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 1:15125 N SCOTTSDALE RD APT 748
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3170
Mailing Address - Country:US
Mailing Address - Phone:773-289-7707
Mailing Address - Fax:
Practice Address - Street 1:26700 S US HIGHWAY 85
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-5024
Practice Address - Country:US
Practice Address - Phone:623-386-6160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0111231223G0001X
IL0190322331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice