Provider Demographics
NPI:1720446164
Name:SHINDELL, MARA ESTHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARA
Middle Name:ESTHER
Last Name:SHINDELL
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 1:4602 OVERLAND ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2671
Mailing Address - Country:US
Mailing Address - Phone:240-676-7890
Mailing Address - Fax:
Practice Address - Street 1:4421 IRVING BLVD NW STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5919
Practice Address - Country:US
Practice Address - Phone:505-821-6910
Practice Address - Fax:505-792-5771
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3594390200000X
NMDD45941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program