Provider Demographics
NPI:1710714787
Name:SHAKERI, ELHAM (DDS)
Entity type:Individual
Prefix:
First Name:ELHAM
Middle Name:
Last Name:SHAKERI
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 1:633 ALCATRAZ AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1005
Mailing Address - Country:US
Mailing Address - Phone:415-987-5466
Mailing Address - Fax:
Practice Address - Street 1:1476 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-1500
Practice Address - Country:US
Practice Address - Phone:707-763-4142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110760122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist