Provider Demographics
NPI:1740966985
Name:AWAN, SHAFIA ASIF (DDS)
Entity type:Individual
Prefix:
First Name:SHAFIA
Middle Name:ASIF
Last Name:AWAN
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 1:1908 TIERRA VISTA DR UNIT 201
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-2794
Mailing Address - Country:US
Mailing Address - Phone:209-689-5296
Mailing Address - Fax:
Practice Address - Street 1:6180 N DECATUR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-1505
Practice Address - Country:US
Practice Address - Phone:702-359-3107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7827122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist