Provider Demographics
NPI:1144715129
Name:FARRAR, SHABNAM SHERRY (DMD)
Entity type:Individual
Prefix:DR
First Name:SHABNAM
Middle Name:SHERRY
Last Name:FARRAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SHABNAM
Other - Middle Name:
Other - Last Name:ESLAMFAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4807 183A TOLL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7872
Mailing Address - Country:US
Mailing Address - Phone:512-690-2211
Mailing Address - Fax:
Practice Address - Street 1:4807 183A TOLL RD STE 100
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7872
Practice Address - Country:US
Practice Address - Phone:512-690-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341801223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice