Provider Demographics
NPI:1750416178
Name:SHAHIDI, ALI S (DDS)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:S
Last Name:SHAHIDI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8524 1/2 ROSECRANS AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723
Mailing Address - Country:US
Mailing Address - Phone:562-633-3082
Mailing Address - Fax:562-633-3067
Practice Address - Street 1:8524 1/2 ROSECRANS AVE
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723
Practice Address - Country:US
Practice Address - Phone:562-633-3082
Practice Address - Fax:562-633-3067
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA509801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD50980Medicaid