Provider Demographics
NPI:1205546108
Name:MICHELLE SHAMARDI, DDS A DENTAL CORPORATION
Entity type:Organization
Organization Name:MICHELLE SHAMARDI, DDS A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAMARDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-760-1051
Mailing Address - Street 1:400 NEWPORT CENTER DR STE 209
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7645
Mailing Address - Country:US
Mailing Address - Phone:949-760-1051
Mailing Address - Fax:
Practice Address - Street 1:400 NEWPORT CENTER DR STE 209
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7645
Practice Address - Country:US
Practice Address - Phone:949-760-1051
Practice Address - Fax:949-760-2654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty