Provider Demographics
NPI:1144997123
Name:SHAFIEY DENTAL GROUP PLLC
Entity type:Organization
Organization Name:SHAFIEY DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFIEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-224-5397
Mailing Address - Street 1:1001 N INTERSTATE 35 E STE 304B
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-4215
Mailing Address - Country:US
Mailing Address - Phone:972-224-5397
Mailing Address - Fax:
Practice Address - Street 1:1001 N INTERSTATE 35 E STE 304B
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4215
Practice Address - Country:US
Practice Address - Phone:972-224-5397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty